Provider Demographics
NPI:1548317571
Name:HEGSTAD, ANDREW LF (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:LF
Last Name:HEGSTAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:20 LAKE ST N
Mailing Address - Street 2:SUITE #311
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-2523
Mailing Address - Country:US
Mailing Address - Phone:651-464-5550
Mailing Address - Fax:651-464-6321
Practice Address - Street 1:20 LAKE ST N
Practice Address - Street 2:SUITE #311
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2523
Practice Address - Country:US
Practice Address - Phone:651-464-5550
Practice Address - Fax:651-464-6321
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MND114361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice