Healthcare Provider Details

I. General information

NPI: 1730298654
Provider Name (Legal Business Name): JOHN F ENGLUND D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

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

100 CENTRAL AVE
OSSEO MN
55369-1202
US

IV. Provider business mailing address

105C SOUTH DR
CIRCLE PINES MN
55014-3319
US

V. Phone/Fax

Practice location:
  • Phone: 763-425-8200
  • Fax: 763-425-0946
Mailing address:
  • Phone: 763-783-8706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7798
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: