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Organization
SUNRISE RIVER DENTAL PA
Active
Organization
SUNRISE RIVER DENTAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESE RYDLUND (CDA, RDA)
(651) 462-7017
Entity
Organization
Contact information
Practice address
26357 FOREST BLVD, WYOMING, MN 55092-8353
(651) 462-7017
Mailing address
26357 FOREST BLVD, WYOMING, MN 55092-8353
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D10152
MN
Other
Enumeration date
12/12/2006
Last updated
08/22/2020
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