Basic Information
| Provider Information | |||||||||
| NPI: | 1801863436 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAHLING | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | THERESE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 NICOLLET MALL | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554022500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123332503 | ||||||||
| FaxNumber: | 6123332503 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 NICOLLET MALL | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554022500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123332503 | ||||||||
| FaxNumber: | 6123332503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2006 | ||||||||
| LastUpdateDate: | 04/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 50802 | MN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 50802 | 01 | MN | MINNESOTA LICENSE | OTHER |