OrganizationActive
Advanced Dermatology Care Medical Cosmetic and Surgery PA
NPI 1073614558 · Dermatology Physician · White Bear Lake, MN
Provider details
- NPI number
- 1073614558
- Entity type
- Organization
- Primary specialty
- Dermatology PhysicianAllopathic & Osteopathic Physicians
- Parent organization
- Advanced Dermatology Care Medical and Surgical Dermatology PA
- Organization subpart
- Yes
- Authorized official
- Olaf Rustad, Owner(651) 484-2724
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
4480 Centerville Rd
White Bear Lake, MN 55127-3674
Phone: (651) 484-2724
Fax: (651) 484-2723
Approximate (ZIP-level) locationGet directions
Mailing address
4480 Centerville Rd
White Bear Lake, MN 55127-3674
Other names (DBA / former)
- Doing business as
- Advanced Dermatology Care
- Doing business as
- Advanced Dermatology Care
Registry dates
- Enumerated
- 2006-09-26
- Last updated
- 2018-11-16
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.