Provider Demographics
NPI:1922243963
Name:SAVSTROM, JACQUELINE ANN (RDH)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:ANN
Last Name:SAVSTROM
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 TOWER DR W
Mailing Address - Street 2:SUITE #130
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-7585
Mailing Address - Country:US
Mailing Address - Phone:651-351-0890
Mailing Address - Fax:651-351-1922
Practice Address - Street 1:5600 NORWICH PKWY
Practice Address - Street 2:
Practice Address - City:OAK PARK HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55082-6482
Practice Address - Country:US
Practice Address - Phone:651-366-0923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH2765124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist