Individual
KATHLEEN VAN THIEU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8650 HUDSON BLVD N STE 105, LAKE ELMO, MN 55042-8416
(952) 444-9511
Mailing address
2200 COUNTY ROAD C W STE 2210, ROSEVILLE, MN 55113-2551
(651) 746-2815
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
D13834
MN
Other
Enumeration date
06/13/2017
Last updated
12/03/2020
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