Individual
MR. DENNIS LEO ANCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPO, LPO
Contact information
Practice address
1854 EVERGREEN DRAW, WOODBURY, MN 55125-2306
(763) 228-5697
Mailing address
1854 EVERGREEN DRAW, WOODBURY, MN 55125-2306
(763) 228-5697
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
1089
MN
224P00000X
Prosthetist
Primary
1089
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1089
BOARD OF PODIATRIC MEDICINE
MN
01
—
CPO04135
AMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS, PROSTHETICS, AND PEDORTHICS
—
Enumeration date
09/28/2019
Last updated
09/28/2019
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