Individual
JUSTIN JAMES GANGESTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
13442 ELMWOOD DR, BAXTER, MN 56425-8400
(218) 829-4207
Mailing address
4940 CIRCLE PINES RD, BAXTER, MN 56425-9501
(218) 851-8108
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D13729
MN
Other
Enumeration date
07/08/2016
Last updated
07/08/2016
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