Individual
MARK IVAN MALTERUD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.,M.A.G.D.
Contact information
Practice address
770 MOUNT CURVE BLVD, SAINT PAUL, MN 55116-1165
(651) 699-2822
(651) 699-3009
Mailing address
770 MOUNT CURVE BLVD., ST. PAUL, MN 55116-1120
(651) 699-2822
(651) 699-3009
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9454
MN
Other
Enumeration date
03/26/2007
Last updated
07/08/2007
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