Organization
COON RAPIDS MODERN DENTISTRY, PC
Active
Other names
Coon Rapids Modern Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
PARVATHI JITHENDRANATHAN (OWNER)
(763) 290-6623
Entity
Organization
Contact information
Practice address
3320 124TH AVE NW, COON RAPIDS, MN 55433-1001
(763) 290-6623
Mailing address
PO BOX 920050, DALLAS, TX 75392-0050
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
02/02/2023
Last updated
02/02/2023
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