Organization
INTEGRA DENTAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GINA L ANDERSLAND D.D.S. (OWNER/DENTIST)
(612) 384-0527
Entity
Organization
Contact information
Practice address
13783 IBIS ST NW, SUITE 400, ANDOVER, MN 55304-4892
(612) 384-0527
Mailing address
13783 IBIS ST NW, SUITE 400, ANDOVER, MN 55304-4892
(612) 384-0527
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D12655
MN
122300000X
Dentist
D13123
MN
Other
Enumeration date
04/30/2013
Last updated
04/30/2013
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