Individual
STACEY FRANCIS ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
2454 HIGHWAY 2, TWO HARBORS, MN 55616-3000
(218) 206-4328
Mailing address
2454 HIGHWAY 2, TWO HARBORS, MN 55616-3000
(218) 206-4328
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H5437
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9184066
DORAL UCARE PROVIDER
MN
01
—
DHS 709417500
MN DENTAL HYG
MN
Enumeration date
04/12/2007
Last updated
07/08/2007
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