Provider Demographics
NPI:1083712152
Name:AMUNDSON, CRAIG W (DDN)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:W
Last Name:AMUNDSON
Suffix:
Gender:M
Credentials:DDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:MAIL CODE 21113A
Mailing Address - Street 2:PO BOX 1309
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-1309
Mailing Address - Country:US
Mailing Address - Phone:952-883-5151
Mailing Address - Fax:952-883-5160
Practice Address - Street 1:450 N SYNDICATE ST #300
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-254-7373
Practice Address - Fax:651-254-7383
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN83781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice