Provider Demographics
NPI:1174515092
Name:LINDGREN, CHERYL (DDS)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:
Last Name:LINDGREN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6936 PINE ARBOR DR S
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-4645
Mailing Address - Country:US
Mailing Address - Phone:651-769-1000
Mailing Address - Fax:651-203-5098
Practice Address - Street 1:6936 PINE ARBOR DR S
Practice Address - Street 2:SUITE 210
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-4645
Practice Address - Country:US
Practice Address - Phone:651-769-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN107871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN522022000Medicaid