Provider Demographics
NPI:1912970062
Name:ANDREASEN, KARL HAAKON (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:HAAKON
Last Name:ANDREASEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1912 LEXINGTON AVE N
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-6154
Mailing Address - Country:US
Mailing Address - Phone:651-636-2420
Mailing Address - Fax:651-636-3199
Practice Address - Street 1:1912 LEXINGTON AVE N
Practice Address - Street 2:SUITE 150
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-6154
Practice Address - Country:US
Practice Address - Phone:651-636-2420
Practice Address - Fax:651-636-3199
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MND109041223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1497814032OtherCLINIC NPI
MN1497814032OtherCLINIC NPI