Provider Demographics
NPI:1609980804
Name:RAETHER, DANIEL GUNDERSON (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:GUNDERSON
Last Name:RAETHER
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 CAMPUS DR
Mailing Address - Street 2:360
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441
Mailing Address - Country:US
Mailing Address - Phone:763-383-1788
Mailing Address - Fax:763-383-1768
Practice Address - Street 1:2855 CAMPUS DR
Practice Address - Street 2:360
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441
Practice Address - Country:US
Practice Address - Phone:763-383-1788
Practice Address - Fax:763-383-1768
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10086122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist