Provider Demographics
NPI:1366507121
Name:FLIGGE AND LARSON PA
Entity Type:Organization
Organization Name:FLIGGE AND LARSON PA
Other - Org Name:WAYZATA FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-475-2464
Mailing Address - Street 1:101 LAKE ST W
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391
Mailing Address - Country:US
Mailing Address - Phone:952-475-2464
Mailing Address - Fax:952-475-2664
Practice Address - Street 1:101 LAKE ST W
Practice Address - Street 2:SUITE 220
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391
Practice Address - Country:US
Practice Address - Phone:952-475-2464
Practice Address - Fax:952-475-2664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty