PHONSUDA CHANTHAVISOUK, RDH, MDT
Dental Therapist
Active
Individual
NPI: 1548844053
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
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