Provider Demographics
NPI:1841356698
Name:MJOLSNES, ALAN DEMING (DDS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:DEMING
Last Name:MJOLSNES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7373 FRANCE AVE S
Mailing Address - Street 2:SUITE 600
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4534
Mailing Address - Country:US
Mailing Address - Phone:952-896-1111
Mailing Address - Fax:952-253-9271
Practice Address - Street 1:7373 FRANCE AVE S
Practice Address - Street 2:SUITE 600
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4534
Practice Address - Country:US
Practice Address - Phone:952-896-1111
Practice Address - Fax:952-253-9271
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN74451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN664315900OtherMEDICAL ASSISTANCE