Individual
DR. DEEPTHI NAMBALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BDS
Contact information
Practice address
SPECIAL HEALTHCARE NEEDS DENTAL CLINIC, MALCOLM HEALTH SCIENCES MOOS TOWER, 515 DELAWARE ST. SE, MINNEAPOLIS, MN 55455
(612) 625-4777
(612) 625-0613
Mailing address
19839 IRIS WAY, LAKEVILLE, MN 55044-3547
(425) 351-0826
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
R890
MN
Other
Enumeration date
10/17/2024
Last updated
10/27/2024
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