Individual
LINDA M MAYTAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
400 4TH ST NW, SUITE A3A, FARIBAULT, MN 55021-5031
(507) 384-6830
(651) 431-5575
Mailing address
400 4TH ST NW, SOUTHERN CITIES CLINIC, FARIBAULT, MN 55021-5031
(507) 384-6830
(651) 431-5575
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
11380
MN
122300000X
Dentist
21230
MA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
21230
MA
Other
Enumeration date
03/12/2007
Last updated
08/27/2015
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