Provider Demographics
NPI:1598926115
Name:RAETHER, GAIL N (DDS)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:N
Last Name:RAETHER
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 1:26420 OAK RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55331-7973
Mailing Address - Country:US
Mailing Address - Phone:720-308-2162
Mailing Address - Fax:
Practice Address - Street 1:7806 MARKET BLVD
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-9440
Practice Address - Country:US
Practice Address - Phone:952-949-1083
Practice Address - Fax:952-949-1084
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2021-08-04
Deactivation Date:2021-07-15
Deactivation Code:
Reactivation Date:2021-08-03
Provider Licenses
StateLicense IDTaxonomies
CO97041223G0001X
CODEN-97041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice