Provider Demographics
NPI:1639126683
Name:RINDELAUB, DARCY JAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARCY
Middle Name:JAY
Last Name:RINDELAUB
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4951 MOREHEAD AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-2633
Mailing Address - Country:US
Mailing Address - Phone:651-324-4270
Mailing Address - Fax:
Practice Address - Street 1:3585 124TH AVE NW
Practice Address - Street 2:SUITE 400
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-1006
Practice Address - Country:US
Practice Address - Phone:763-767-1524
Practice Address - Fax:763-767-1528
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND113651223P0221X
WI6666-0151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN122648700OtherMA
98G41RIOtherBLUE CROSS
1860394OtherUNITED CONCORDIA