Provider Demographics
NPI:1457510596
Name:MAGNUSON, SARAH J (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:J
Last Name:MAGNUSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:J
Other - Last Name:JORGENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7500 STATE HIGHWAY 55
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREENFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55373-6620
Mailing Address - Country:US
Mailing Address - Phone:763-575-8038
Mailing Address - Fax:763-575-8039
Practice Address - Street 1:7500 STATE HIGHWAY 55
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENFIELD
Practice Address - State:MN
Practice Address - Zip Code:55373-6620
Practice Address - Country:US
Practice Address - Phone:763-575-8038
Practice Address - Fax:763-575-8039
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND125381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice