Provider Demographics
NPI:1487719019
Name:INDREHUS, JAMES ERLING (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ERLING
Last Name:INDREHUS
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 1:6425 NICOLLET AVE SO
Mailing Address - Street 2:SUITE 318
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-1668
Mailing Address - Country:US
Mailing Address - Phone:612-861-4850
Mailing Address - Fax:612-861-6251
Practice Address - Street 1:6425 NICOLLET AVE SO
Practice Address - Street 2:SUITE 318
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-1668
Practice Address - Country:US
Practice Address - Phone:612-861-4850
Practice Address - Fax:612-861-6251
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6868122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN07670INOtherBLUE CROSS