Individual
DR. BREYNNE STACEY FORDAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
14727 60TH ST. N, STILLWATER, MN 55082
(651) 439-9060
(651) 379-9893
Mailing address
14727 60TH ST. N, STILLWATER, MN 55082
(651) 439-9060
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
12259
MN
1223G0001X
General Practice Dentistry
Primary
D12259
MN
Other
Enumeration date
08/08/2006
Last updated
11/30/2012
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