Provider Demographics
NPI:1275667396
Name:SHAND, ADAM GUSTAV (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:GUSTAV
Last Name:SHAND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4948 34TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-1504
Mailing Address - Country:US
Mailing Address - Phone:612-722-4676
Mailing Address - Fax:
Practice Address - Street 1:414 RAILWAY ST NW
Practice Address - Street 2:
Practice Address - City:LONSDALE
Practice Address - State:MN
Practice Address - Zip Code:55046-9661
Practice Address - Country:US
Practice Address - Phone:507-744-2359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND121491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice