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General NPI Number Information
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NPI Number | 1639126683
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Entity Type | Individual
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Provider Name | DARCY JAY RINDELAUB D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 3585 124TH AVE NW SUITE 400
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City | COON RAPIDS
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State | MN
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Zip | 55433-1006
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Country | US
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Telephone | 763-767-1524
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Fax | 763-767-1528
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Provider Business Mailing Address
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Address Line | 4951 MOREHEAD AVE
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55110-2633
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Country | US
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Telephone | 651-324-4270
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D11365
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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 | 6666-015
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License Number State | WI
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