NPI 1497061766

Rose a Malkovich, CLDA

Practitioner Dental Assistant Minneapolis, MN

Practice location

Address: 3657 Minnehaha Ave, Minneapolis, MN 55406-2628
Phone: (612) 721-1689

Registered specialties

Dental Assistant Primary

Dental Providers Taxonomy 126800000X Licence A4520 (MN)

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Registry record

NPI: 1497061766
Entity type: Individual
Sex (as registered): Female
NPI issued: 25 Aug 2010
Record last updated: 25 Aug 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.