Provider Demographics
NPI:1336441807
Name:PFEIFFER BEDARD, ANGELA (DDS)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:PFEIFFER BEDARD
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 1:165 19TH ST S
Mailing Address - Street 2:SUITE #101
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-2153
Mailing Address - Country:US
Mailing Address - Phone:320-253-9270
Mailing Address - Fax:320-255-5413
Practice Address - Street 1:165 19TH ST S
Practice Address - Street 2:SUITE #101
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2153
Practice Address - Country:US
Practice Address - Phone:320-253-9270
Practice Address - Fax:320-255-5413
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND129161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice