Individual
MISS ROSE A MALKOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CLDA
Contact information
Practice address
3657 MINNEHAHA AVE, MINNEAPOLIS, MN 55406-2628
(612) 721-1689
Mailing address
3657 MINNEHAHA AVE, MINNEAPOLIS, MN 55406-2628
(612) 721-1689
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
A4520
MN
Other
Enumeration date
08/25/2010
Last updated
08/25/2010
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