Individual
EDGAR MANTILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2001 BLOOMINGTON AVE S, MINNEAPOLIS, MN 55404-3074
(612) 301-3433
(612) 627-4205
Mailing address
2001 BLOOMINGTON AVE S, MINNEAPOLIS, MN 55404-3074
(612) 301-3433
(612) 627-4205
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D11889
MN
Other
Enumeration date
08/03/2006
Last updated
10/24/2014
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