Healthcare Provider Details

I. General information

NPI: 1689801771
Provider Name (Legal Business Name): SUGANYA APPUGOUNDER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6411 RICHFIELD PKWY
RICHFIELD MN
55423
US

IV. Provider business mailing address

547 S 10TH ST
MINNEAPOLIS MN
55404-1013
US

V. Phone/Fax

Practice location:
  • Phone: 612-869-3440
  • Fax:
Mailing address:
  • Phone: 952-992-0880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberS77
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: