Provider Demographics
NPI:1164492559
Name:DANIELSON, JEANNE (RDH)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8960 SPRINGBROOK DR NW
Mailing Address - Street 2:SUITE 150
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-5852
Mailing Address - Country:US
Mailing Address - Phone:763-784-7570
Mailing Address - Fax:
Practice Address - Street 1:8960 SPRINGBROOK DR NW
Practice Address - Street 2:SUITE 150
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5852
Practice Address - Country:US
Practice Address - Phone:763-784-7570
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH6666124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist