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General NPI Number Information
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NPI Number | 1831373604
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Entity Type | Individual
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Provider Name | STEVEN MICHAEL EDLUND D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 04/27/2008
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Provider Practice Location Address
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Address Line | 1021 BANDANA BLVD E BANDANA SQUARE, SUITE #100
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City | SAINT PAUL
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State | MN
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Zip | 55108-5113
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Country | US
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Telephone | 651-645-0449
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Fax | 651-647-4951
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Provider Business Mailing Address
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Address Line | 1437 OSCEOLA AVE
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City | SAINT PAUL
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State | MN
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Zip | 55105-2312
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Country | US
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Telephone | 651-698-5146
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D12097
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License Number State | MN
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