Healthcare Provider Details

I. General information

NPI: 1114076692
Provider Name (Legal Business Name): CANDACE ANNETTE MENSING D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2743 SUPERIOR DR NW
ROCHESTER MN
55901-1773
US

IV. Provider business mailing address

2743 SUPERIOR DR NW
ROCHESTER MN
55901-1773
US

V. Phone/Fax

Practice location:
  • Phone: 507-288-8060
  • Fax: 507-288-3344
Mailing address:
  • Phone: 507-288-8060
  • Fax: 507-288-3344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number8116
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: