Provider Demographics
NPI:1366995169
Name:MITTELSTEADT, MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MITTELSTEADT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 E NICOLLET BLVD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337
Mailing Address - Country:US
Mailing Address - Phone:952-435-0370
Mailing Address - Fax:952-435-0377
Practice Address - Street 1:625 E NICOLLET BLVD
Practice Address - Street 2:SUITE 340
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337
Practice Address - Country:US
Practice Address - Phone:952-435-0370
Practice Address - Fax:952-435-0377
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1511121223E0200X
MND141511223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics