Individual
LONG THAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
4243 4TH AVE S, MINNEAPOLIS, MN 55409-2113
(612) 822-9030
Mailing address
4243 4TH AVE S, MINNEAPOLIS, MN 55409-2113
(612) 822-9030
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D13413
MN
Other
Enumeration date
06/18/2014
Last updated
06/18/2014
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