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Organization
ALYSSA A HEDSTROM, D.D.S.
Active
Organization
ALYSSA A HEDSTROM, D.D.S.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALYSSA A HEDSTROM D.D.S. (OWNER)
(218) 387-2774
Entity
Organization
Contact information
Practice address
303 E. 3RD ST., GRAND MARAIS, MN 55604-0670
(218) 387-2774
(218) 387-1393
Mailing address
303 E. 3RD ST., P.O. BOX 670, GRAND MARAIS, MN 55604-0670
(218) 387-2774
(218) 387-1393
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D11942
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
580060000
—
MN
Enumeration date
06/12/2007
Last updated
05/01/2008
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