Individual
NICOLE MATHEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DT
Contact information
Practice address
636 BROADWAY ST NE, MINNEAPOLIS, MN 55413-2164
(612) 746-1530
(612) 746-1531
Mailing address
636 BROADWAY ST NE, MINNEAPOLIS, MN 55413-2164
(612) 746-1530
(612) 746-1531
Taxonomy
Speciality
Code
Description
License number
State
125J00000X
Dental Therapist
Primary
DT96
MN
Other
Enumeration date
02/13/2018
Last updated
02/13/2018
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