Healthcare Provider Details

I. General information

NPI: 1083970750
Provider Name (Legal Business Name): DANAE MARIE SEYFFER DT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2012
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 BLOOMINGTON AVE
MINNEAPOLIS MN
55404-3074
US

IV. Provider business mailing address

118 5TH AVE N
HOPKINS MN
55343-7303
US

V. Phone/Fax

Practice location:
  • Phone: 612-301-0918
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code125J00000X
TaxonomyDental Therapist
License NumberDT7
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code125K00000X
TaxonomyAdvanced Practice Dental Therapist
License NumberDT7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: