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Individual

EVERAID UBANGOH FOKIM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MDT

Contact information

Practice address
9920 FOLEY BLVD NW, COON RAPIDS, MN 55433-4579
(763) 317-1166
Mailing address
2312 7TH ST N, NORTH ST PAUL, MN 55109-2845
(165) 180-8874

Taxonomy

Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
H10783
MN
125J00000X
Dental Therapist
Primary
DT130
MN

Other

Enumeration date
09/20/2021
Last updated
09/20/2021
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