Individual
LUCKY VANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
409 DUNLAP ST N, SAINT PAUL, MN 55104-4201
(651) 290-9200
Mailing address
2228 E LAKE ST, MINNEAPOLIS, MN 55407-4321
Taxonomy
Speciality
Code
Description
License number
State
125J00000X
Dental Therapist
DT71
MN
125K00000X
Advanced Practice Dental Therapist
Primary
DT71
MN
Other
Enumeration date
01/12/2018
Last updated
05/02/2022
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