Individual
KERI ISHIBASHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
303 MAIN ST, BIGFORK, MN 56628-2001
(218) 743-3600
Mailing address
303 MAIN ST, BIGFORK, MN 56628-2001
(218) 743-3600
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D14053
MN
Other
Enumeration date
06/22/2018
Last updated
01/08/2021
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