Provider Demographics
NPI:1447539242
Name:DAHLGREN, AMY ELIZABETH (DDS)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:ELIZABETH
Last Name:DAHLGREN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:ELIZABETH
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2334 119TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-5412
Mailing Address - Country:US
Mailing Address - Phone:651-246-7367
Mailing Address - Fax:
Practice Address - Street 1:4255 PHEASANT RIDGE DR NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-4537
Practice Address - Country:US
Practice Address - Phone:763-225-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2012-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12949122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist