Basic Information
| Provider Information | |||||||||
| NPI: | 1710357074 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALB | ||||||||
| FirstName: | SANDU | ||||||||
| MiddleName: | FLORIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19000 31ST AVE N | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554471085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635330055 | ||||||||
| FaxNumber: | 7635330057 | ||||||||
| Practice Location | |||||||||
| Address1: | 5001 WINNETKA AVE N | ||||||||
| Address2: | |||||||||
| City: | NEW HOPE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554284230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635330055 | ||||||||
| FaxNumber: | 7635330057 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2015 | ||||||||
| LastUpdateDate: | 09/30/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | LGL10 | MN | Y | Dental Providers | Dentist |
No ID Information.