Individual
MY PANG KOU VANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M
Contact information
Practice address
1590 ROBERT ST S, WEST ST PAUL, MN 55118-3403
(651) 300-0949
Mailing address
386 WINIFRED ST E, SAINT PAUL, MN 55107-2424
(651) 226-5110
Taxonomy
Speciality
Code
Description
License number
State
125J00000X
Dental Therapist
Primary
DT84
MN
Other
Enumeration date
12/01/2017
Last updated
12/01/2017
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