Provider Demographics
NPI:1952388407
Name:PRESTON-BROESDEN, BARB LYNN (DDS)
Entity Type:Individual
Prefix:MS
First Name:BARB
Middle Name:LYNN
Last Name:PRESTON-BROESDEN
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 1:4800 NICOLLET AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-5511
Mailing Address - Country:US
Mailing Address - Phone:612-824-2481
Mailing Address - Fax:612-821-9616
Practice Address - Street 1:4800 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55419-5511
Practice Address - Country:US
Practice Address - Phone:612-824-2481
Practice Address - Fax:612-821-9616
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice