Provider Demographics
NPI:1134266869
Name:TROSELIUS, JOHN HAROLD (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HAROLD
Last Name:TROSELIUS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5776 WILLOW LN N
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-5646
Mailing Address - Country:US
Mailing Address - Phone:651-786-6245
Mailing Address - Fax:
Practice Address - Street 1:9120 BALTIMORE ST NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-4337
Practice Address - Country:US
Practice Address - Phone:763-786-1560
Practice Address - Fax:763-786-4390
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN83481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice