Healthcare Provider Details

I. General information

NPI: 1619994480
Provider Name (Legal Business Name): MAUREEN A. OHLAND DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 LEXINGTON AVE N
ROSEVILLE MN
55113-6167
US

IV. Provider business mailing address

558 RYAN AVE W
ROSEVILLE MN
55113-6644
US

V. Phone/Fax

Practice location:
  • Phone: 651-488-5557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD10264
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: