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General NPI Number Information
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NPI Number | 1265763338
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Entity Type | Organization
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Legal Business Name | NORMANDALE DENTAL, P.A.
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Dates
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Enumeration Date | 01/28/2010
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Last Update Date | 08/13/2012
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Provider Practice Location Address
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Address Line | 10700 NORMANDALE BLVD
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City | BLOOMINGTON
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State | MN
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Zip | 55437-2700
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Country | US
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Telephone | 952-888-9661
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Fax |
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Provider Business Mailing Address
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Address Line | 10700 NORMANDALE BLVD
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City | BLOOMINGTON
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State | MN
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Zip | 55437-2700
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Country | US
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Telephone | 952-888-9661
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, DENTIST OWNER
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Name | DR. RENEE JEAN LEHN
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Credential | DDS
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Telephone | 952-888-9661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D11368
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License Number State | MN
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