Provider Demographics
NPI:1558961003
Name:IVERSON, MAREN ELIZABETH (DDS)
Entity Type:Individual
Prefix:
First Name:MAREN
Middle Name:ELIZABETH
Last Name:IVERSON
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 1:6545 FRANCE AVE S STE 390
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2121
Mailing Address - Country:US
Mailing Address - Phone:952-926-3534
Mailing Address - Fax:952-926-7085
Practice Address - Street 1:6545 FRANCE AVE S STE 390
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2121
Practice Address - Country:US
Practice Address - Phone:952-926-3534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR776390200000X
MND145291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty