=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952500779
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINA L VANGUILDER DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2007
-----------------------------------------------------
Last Update Date | 04/28/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5766 BLACKSHIRE PATH
-----------------------------------------------------
City | INVER GROVE HEIGHTS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55076-2441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-457-8666
-----------------------------------------------------
Fax | 651-554-9776
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 230 WENTWORTH AVE E
-----------------------------------------------------
City | WEST ST PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55118-3525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-457-8866
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | D12401
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------