MEDICARE: DEAN A FLUGSTAD DDS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	7075	MN

General Provider Information

NPI Number	:	1154302974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEAN A FLUGSTAD DDS PA

Provider Business Mailing Address
First Line	:	113 W CENTER ST
Second Line	:
City	:	LAKE CITY
State	:	MN
Zip	:	55041-1635
Country	:	US
Telephone Number	:	651-345-3335
Fax Number	:	651-345-3336

Provider Business Practice Location Address
First Line	:	113 W CENTER ST
Second Line	:
City	:	LAKE CITY
State	:	MN
Zip	:	55041-1635
Country	:	US
Telephone Number	:	651-345-3335
Fax Number	:	651-345-3336

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. DEAN ALBERT FLUGSTAD
Credential	:	DDS
Telephone Number	:	651-345-3335

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	08/05/2008

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