Provider Demographics
NPI:1851828214
Name:HOLMGREN, JANNA RAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANNA
Middle Name:RAE
Last Name:HOLMGREN
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 1:4749 MARYLAND AVE N
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55428-4635
Mailing Address - Country:US
Mailing Address - Phone:763-772-6304
Mailing Address - Fax:
Practice Address - Street 1:9600 UPLAND LN N STE 200
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4496
Practice Address - Country:US
Practice Address - Phone:763-416-0037
Practice Address - Fax:763-420-5428
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND138141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice