Provider Demographics
NPI:1073727293
Name:FLORENA LLC
Entity Type:Organization
Organization Name:FLORENA LLC
Other - Org Name:DR. ANGELA WANDERA AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR. ANGELA WANDERA
Authorized Official - Prefix:
Authorized Official - First Name:R.
Authorized Official - Middle Name:ANGELA
Authorized Official - Last Name:WANDERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-941-7393
Mailing Address - Street 1:8785 COLUMBINE RD
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-6695
Mailing Address - Country:US
Mailing Address - Phone:952-941-7393
Mailing Address - Fax:952-941-2162
Practice Address - Street 1:8785 COLUMBINE RD
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-6695
Practice Address - Country:US
Practice Address - Phone:952-941-7393
Practice Address - Fax:952-941-2162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND116181223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty