Provider Demographics
NPI:1942266432
Name:RYDELL, ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:RYDELL
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:PO BOX 23029
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423
Mailing Address - Country:US
Mailing Address - Phone:612-861-9123
Mailing Address - Fax:612-861-9155
Practice Address - Street 1:1121 TOWN CENTRE DR
Practice Address - Street 2:SUITE #200
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-1199
Practice Address - Country:US
Practice Address - Phone:651-454-4771
Practice Address - Fax:651-406-9298
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10626122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist