Individual
NICOLETTE THERESE PORTTIIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
308 BLATTNER DR # A, AVON, MN 56310-4531
(320) 356-7374
Mailing address
308 BLATTNER DR # A, AVON, MN 56310-4531
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D14514
MN
Other
Enumeration date
04/27/2020
Last updated
12/13/2021
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