DR. Breynne Stacey Fordahl, D.D.S.

NPI #1790795235 in Stillwater, Minnesota

Provider Information

NPI Number: 1790795235
Entity Type: Individual
Name: DR. Breynne Stacey Fordahl, D.D.S.
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist - General Practice
Credential: D.D.S.
Enumeration Date: Aug 8, 2006
Last Updated: Nov 30, 2012

Practice Location

Address: 14727 60TH ST. N
City: Stillwater
State: Minnesota
ZIP Code: 55082
Phone: (651) 439-9060

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X
Dentist - General Practice — General Practice	1223G0001X	Primary

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