Organization
TONKA SMILES
Active
Other names
Axel Bergstedt and Johnson PA
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY M BERGSTEADT DDS (OWNER DENTIST)
(952) 938-8533
Entity
Organization
Contact information
Practice address
11601 MINNETONKA MILLS RD, STE D40, MINNETONKA, MN 55305
(952) 938-8533
(952) 938-9321
Mailing address
11601 MINNETONKA MILLS RD, STE D40, MINNETONKA, MN 55305
(952) 938-8533
(952) 938-9321
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
10769
MN
122300000X
Dentist
11571
MN
122300000X
Dentist
Primary
8734
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
056216500
—
MN
05
—
168135400
—
MN
05
—
773218000
—
MN
Enumeration date
08/22/2006
Last updated
07/16/2008
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