Individual
PARK XIONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
636 BROADWAY ST NE, MINNEAPOLIS, MN 55413-2164
(612) 746-1530
Mailing address
2590 49TH ST E, INVER GROVE HEIGHTS, MN 55076-1158
Taxonomy
Speciality
Code
Description
License number
State
125J00000X
Dental Therapist
Primary
DT135
MN
Other
Enumeration date
02/10/2021
Last updated
02/10/2021
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