Provider Demographics
NPI:1821156779
Name:NEDRELOW, STEVEN J (DDS MSD PA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:NEDRELOW
Suffix:
Gender:M
Credentials:DDS MSD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 SW 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-3385
Mailing Address - Country:US
Mailing Address - Phone:320-235-3102
Mailing Address - Fax:320-235-7840
Practice Address - Street 1:525 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3385
Practice Address - Country:US
Practice Address - Phone:320-235-3102
Practice Address - Fax:320-235-7840
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN74501223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics