Provider Demographics
NPI:1245294792
Name:FROEBER, PATTI ANN (DDS)
Entity type:Individual
Prefix:MS
First Name:PATTI
Middle Name:ANN
Last Name:FROEBER
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 1:312 CENTRAL AVE SE
Mailing Address - Street 2:SUITE 440
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414
Mailing Address - Country:US
Mailing Address - Phone:612-379-2428
Mailing Address - Fax:612-379-0538
Practice Address - Street 1:312 CENTRAL AVE SE
Practice Address - Street 2:SUITE 440
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414
Practice Address - Country:US
Practice Address - Phone:612-379-2428
Practice Address - Fax:612-379-0538
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2009-10-21
Deactivation Date:2006-04-13
Deactivation Code:
Reactivation Date:2007-04-13
Provider Licenses
StateLicense IDTaxonomies
MN102721223G0001X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment