Provider Demographics
NPI:1295700334
Name:SUNDQUIST, MELINDA JEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:JEAN
Last Name:SUNDQUIST
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 1:2236 SEABURY AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-1452
Mailing Address - Country:US
Mailing Address - Phone:612-672-0282
Mailing Address - Fax:
Practice Address - Street 1:13040 RIVERDALE DR NW
Practice Address - Street 2:SUITE 600
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-8406
Practice Address - Country:US
Practice Address - Phone:763-323-3042
Practice Address - Fax:763-576-3139
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10902122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist