Provider Demographics
NPI:1548323033
Name:INDOVINA, ANTHONY A JR (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:A
Last Name:INDOVINA
Suffix:JR
Gender:M
Credentials:DDS
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Mailing Address - Street 1:2130 CLIFF RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2485
Mailing Address - Country:US
Mailing Address - Phone:651-452-6933
Mailing Address - Fax:651-905-3061
Practice Address - Street 1:2130 CLIFF RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2485
Practice Address - Country:US
Practice Address - Phone:651-452-6933
Practice Address - Fax:651-905-3061
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MND120451223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNV05435Medicare UPIN