Individual
MARI LIESTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
201 SANDBERG RD, MONTICELLO, MN 55362-8906
(763) 295-5400
Mailing address
3120 NORTHDALE BLVD NW UNIT 240, COON RAPIDS, MN 55433-2996
(320) 217-9940
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D14650
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/12/2020
Last updated
09/01/2021
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