Healthcare Provider Details

I. General information

NPI: 1154302974
Provider Name (Legal Business Name): DEAN A FLUGSTAD DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 W CENTER ST
LAKE CITY MN
55041-1635
US

IV. Provider business mailing address

113 W CENTER ST
LAKE CITY MN
55041-1635
US

V. Phone/Fax

Practice location:
  • Phone: 651-345-3335
  • Fax: 651-345-3336
Mailing address:
  • Phone: 651-345-3335
  • Fax: 651-345-3336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7075
License Number StateMN

VIII. Authorized Official

Name: DR. DEAN ALBERT FLUGSTAD
Title or Position: DENTIST
Credential: DDS
Phone: 651-345-3335