Individual
HATTIE L. THORN-BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
1315 E 24TH ST, MINNEAPOLIS, MN 55404-3975
(612) 721-9825
(612) 721-2904
Mailing address
1315 E 24TH ST, MINNEAPOLIS, MN 55404-3975
(612) 721-9825
(612) 721-2904
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D8307
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
942317600
—
MN
Enumeration date
06/22/2005
Last updated
10/01/2012
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