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Individual

PATHAMAS CHANTARACHERD MITTMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DDS, MS

Contact information

Practice address
3475 PLYMOUTH BLVD STE 200, PLYMOUTH, MN 55447-1539
(763) 577-2484
(763) 577-1375
Mailing address
3475 PLYMOUTH BLVD STE 200, PLYMOUTH, MN 55447-1539
(763) 577-2484
(763) 577-1375

Taxonomy

Speciality
Code
Description
License number
State
1223X2210X
Orofacial Pain Dentistry
Primary
S187
MN

Other

Enumeration date
09/13/2022
Last updated
09/13/2022
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