Provider Demographics
NPI:1457459521
Name:STENDAHL, CHARLES GILBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:GILBERT
Last Name:STENDAHL
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 1:14049 DUNBAR CT
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7753
Mailing Address - Country:US
Mailing Address - Phone:952-423-3154
Mailing Address - Fax:
Practice Address - Street 1:825 NICOLLET MALL
Practice Address - Street 2:SUITE 1921
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-2793
Practice Address - Country:US
Practice Address - Phone:612-332-5916
Practice Address - Fax:612-332-2659
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNS 211223P0700X
IL1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics