Provider Demographics
NPI:1285732511
Name:SINNA, LEO CARL (DDS)
Entity type:Individual
Prefix:DR
First Name:LEO
Middle Name:CARL
Last Name:SINNA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 SOUTH LAKE STREET
Mailing Address - Street 2:#205
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025
Mailing Address - Country:US
Mailing Address - Phone:651-464-6988
Mailing Address - Fax:651-464-2920
Practice Address - Street 1:1068 SOUTH LAKE STREET
Practice Address - Street 2:#205
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025
Practice Address - Country:US
Practice Address - Phone:651-464-6988
Practice Address - Fax:651-464-2920
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7708122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist