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General NPI Number Information
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NPI Number | 1073727293
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Entity Type | Organization
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Legal Business Name | FLORENA LLC
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 02/15/2017
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Provider Practice Location Address
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Address Line | 8785 COLUMBINE RD
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-6695
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Country | US
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Telephone | 952-941-7393
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Fax | 952-941-2162
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Provider Business Mailing Address
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Address Line | 8785 COLUMBINE RD
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-6695
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Country | US
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Telephone | 952-941-7393
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Fax | 952-941-2162
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Authorized Official
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Title or Position | DR. ANGELA WANDERA
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Name | R. ANGELA WANDERA
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Credential |
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Telephone | 952-941-7393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D11618
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D11618
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License Number State | MN
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