Individual
COLE BOEREMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1965 CLIFF LAKE RD, EAGAN, MN 55122-2590
(651) 452-4828
Mailing address
1965 CLIFF LAKE RD, EAGAN, MN 55122-2590
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D13366
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
MN
Other
Enumeration date
04/07/2014
Last updated
07/01/2014
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