Provider Demographics
NPI:1891740304
Name:EHLEN, CYNTHIA ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:ANN
Last Name:EHLEN
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 1:250 CENTRAL AVE N
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-1284
Mailing Address - Country:US
Mailing Address - Phone:952-473-4900
Mailing Address - Fax:952-473-4672
Practice Address - Street 1:250 CENTRAL AVE N
Practice Address - Street 2:SUITE 202
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1284
Practice Address - Country:US
Practice Address - Phone:952-473-4900
Practice Address - Fax:952-473-4672
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND107751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice