Individual
JULIE BONHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
803 3RD ST. SE, SUITE 330, LITTLE FALLS, MN 56345
(206) 315-6536
Mailing address
8960 SPRINGBROOK DR NW STE 150, MINNEAPOLIS, MN 55433-5810
(320) 631-5653
Taxonomy
Speciality
Code
Description
License number
State
125J00000X
Dental Therapist
Primary
DT95
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
467477400
—
MN
Enumeration date
02/15/2018
Last updated
12/05/2018
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