Individual
JACILYN THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1632 WASHINGTON ST NE, MINNEAPOLIS, MN 55413-1336
(612) 789-2853
Mailing address
1632 WASHINGTON ST NE, MINNEAPOLIS, MN 55413-1336
(612) 789-2853
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
D10597
MN
1223G0001X
General Practice Dentistry
Primary
D15097
MN
Other
Enumeration date
06/17/2024
Last updated
06/28/2024
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