Individual
JACQUELINE MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
515 DELAWARE ST SE FL 6, MINNEAPOLIS, MN 55455-0357
(612) 625-5945
Mailing address
7-530 MOOS TOWER, 515 DELAWARE ST SE, MINNEAPOLIS, MN 55455-0357
(612) 625-5945
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
37453
CA
Other
Enumeration date
12/05/2008
Last updated
06/04/2019
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