Individual
JESSICA TIEN THUY NGUYEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
107 12TH ST SW STE 2, FOREST LAKE, MN 55025-1467
(651) 964-2013
Mailing address
1190 POLO CLUB RD, INDEPENDENCE, MN 55359-9234
(763) 267-9671
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D11410
MN
Other
Enumeration date
07/02/2020
Last updated
07/02/2020
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