PHONSUDA CHANTHAVISOUK, RDH, MDT

Dental Therapist

Active Individual
NPI: 1548844053

Practice Address

728 E HENNEPIN AVE
Minneapolis, MN 55414

Phone: (612) 746-1530

Specialties

Specialty Code Primary License
Dental Therapist 125J00000X Yes DT137 (MN)
Dental Hygienist 124Q00000X No H11002 (MN)

Frequently Asked Questions

NPI 1548844053 is the National Provider Identifier for PHONSUDA CHANTHAVISOUK, RDH, MDT, a Dental Therapist provider located in Minneapolis, MN. This NPI was enumerated on May 11, 2021.
PHONSUDA CHANTHAVISOUK, RDH, MDT practices at 728 E HENNEPIN AVE, Minneapolis, MN 55414.

Quick Facts

NPI
1548844053
Type
Individual
Enumerated
May 11, 2021
Last Updated
Aug 8, 2023

Nearby Providers