Individual
DR. CARLOS ERNESTO CAMPODONICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
11806 ABERDEEN ST NE STE 150, BLAINE, MN 55449-4748
(763) 786-1545
(763) 786-2939
Mailing address
11806 ABERDEEN ST NE STE 150, BLAINE, MN 55449-4748
(763) 786-1545
(763) 786-2939
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D12159
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
767695000
—
MN
Enumeration date
04/16/2007
Last updated
08/02/2016
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