Individual
KAYLA DAWN HANNINEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
6140 LAKE LINDEN DR, EXCELSIOR, MN 55331-2954
(952) 474-4123
Mailing address
305 PONDVIEW LN, CHASKA, MN 55318-2873
(952) 297-5515
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D14045
MN
Other
Enumeration date
06/20/2018
Last updated
06/20/2018
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