Individual
MARGIE KENNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
8960 SPRINGBROOK DR NW, SUITE 150, COON RAPIDS, MN 55433-5852
(763) 784-7570
Mailing address
8960 SPRINGBROOK DR NW, SUITE 150, COON RAPIDS, MN 55433-5852
(763) 784-7570
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D10224
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
949815000
—
MN
Enumeration date
01/27/2006
Last updated
02/27/2012
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