Fordahl, Breynne Stacey

Fordahl, Breynne Stacey is an individual health care provider with primary practice located at 14727 60Th St. N , Stillwater MN 55082. She recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / General Practice. Dental Providers / General Practice is her primary health care specialty. Fordahl, Breynne Stacey can be contacted via phone (651) 439-9060.

Contact Information

Primary practice address
14727 60Th St. N Stillwater MN 55082
Phone: (651) 439-9060
Fax: (651) 379-9893
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 12259 Minnesota
Dental Providers / General Practice 1223G0001X D12259 Minnesota

Profile Details

NPI number 1790795235
LBN Legal business name Fordahl, Breynne Stacey
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 8th, 2006
Last updated Nov 30th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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