Individual
MIRANDA THACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
701 25TH AVE S STE 400, MINNEAPOLIS, MN 55454-1443
(612) 626-7232
Mailing address
8994 NEILL LAKE RD, EDEN PRAIRIE, MN 55347-2036
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D15303
MN
Other
Enumeration date
06/28/2025
Last updated
06/28/2025
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