Individual
SAMANTHA MICHELLE FONKERT HANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
7710 BROOKLYN BLVD FL 1, BROOKLYN PARK, MN 55443-2979
(651) 292-9331
Mailing address
10996 INDIAN BEACH CIR, SPICER, MN 56288-9511
(320) 212-4398
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D14917
MN
Other
Enumeration date
06/14/2023
Last updated
06/14/2023
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