Provider Demographics
NPI:1558101246
Name:TATARYN, ALEKSA (DDS)
Entity type:Individual
Prefix:
First Name:ALEKSA
Middle Name:
Last Name:TATARYN
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 1:4995 ROSEWOOD LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-2099
Mailing Address - Country:US
Mailing Address - Phone:763-350-6503
Mailing Address - Fax:
Practice Address - Street 1:1632 WASHINGTON ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1336
Practice Address - Country:US
Practice Address - Phone:612-789-2853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND150591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice