Individual
KYLIE MIRANDA ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ADT
Contact information
Practice address
3650 BRADDOCK AVE NE, BUFFALO, MN 55313-3672
(763) 270-6900
Mailing address
9395 WELLINGTON LN N, MAPLE GROVE, MN 55369-4150
(763) 381-2985
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
H10758
MN
125J00000X
Dental Therapist
Primary
DT128
MN
Other
Enumeration date
09/23/2019
Last updated
07/29/2025
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