Provider Demographics
NPI:1376602326
Name:BALFOUR, ANNE BRIDGET (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:BRIDGET
Last Name:BALFOUR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1476 ELEANOR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-2233
Mailing Address - Country:US
Mailing Address - Phone:651-698-2673
Mailing Address - Fax:
Practice Address - Street 1:13911 RIDGEDALE DR STE 395
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1770
Practice Address - Country:US
Practice Address - Phone:952-545-8603
Practice Address - Fax:952-545-4371
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2008-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND120731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN184551900Medicaid