Provider Demographics
NPI:1376628081
Name:MCGREGORSAARELA, CINDY ELLEN
Entity Type:Individual
Prefix:MS
First Name:CINDY
Middle Name:ELLEN
Last Name:MCGREGORSAARELA
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:CINDY
Other - Middle Name:ELLEN
Other - Last Name:MCGREGOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:13725 57TH PL N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-3599
Mailing Address - Country:US
Mailing Address - Phone:763-559-9682
Mailing Address - Fax:
Practice Address - Street 1:5585 LA CENTRE AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:ALBERTVILLE
Practice Address - State:MN
Practice Address - Zip Code:55301-4519
Practice Address - Country:US
Practice Address - Phone:763-497-7730
Practice Address - Fax:763-497-0177
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND112741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice