Individual
MRS. TERESA BUSHNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
636 BROADWAY ST NE, MINNEAPOLIS, MN 55413-2164
(612) 746-1530
Mailing address
10845 E WEGENER RD, HIBBING, MN 55746-8231
Taxonomy
Speciality
Code
Description
License number
State
125J00000X
Dental Therapist
Primary
DT33
MN
Other
Enumeration date
01/06/2015
Last updated
03/17/2018
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