Healthcare Provider Details

I. General information

NPI: 1649389636
Provider Name (Legal Business Name): SUZANNE FELTON BAUERFELD RH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6665 CAHILL AVE
INVER GROVE HEIGHTS MN
55076-2026
US

IV. Provider business mailing address

6338 KALEN DR
WOODBURY MN
55129-9579
US

V. Phone/Fax

Practice location:
  • Phone: 651-455-1247
  • Fax: 651-455-8375
Mailing address:
  • Phone: 651-458-8933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number3933
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: