Provider Demographics
NPI:1184616005
Name:FLODIN, PHILIP V
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:V
Last Name:FLODIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 BROADWAY ST S
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-5175
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2850 CURVE CREST BLVD W
Practice Address - Street 2:SUITE 200
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-4039
Practice Address - Country:US
Practice Address - Phone:651-439-9400
Practice Address - Fax:651-439-9402
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN87371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice