Provider Demographics
NPI:1174614572
Name:ORANDI, SHIRENE R (DDS)
Entity type:Individual
Prefix:
First Name:SHIRENE
Middle Name:R
Last Name:ORANDI
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 1:4725 PEBBLE BEACH WAY
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-2171
Mailing Address - Country:US
Mailing Address - Phone:651-340-6800
Mailing Address - Fax:651-688-8650
Practice Address - Street 1:4178 KNOB DR
Practice Address - Street 2:SUITE D
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2888
Practice Address - Country:US
Practice Address - Phone:651-688-3545
Practice Address - Fax:651-688-8650
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN10687OtherLICENSE NUMBER