Individual
CASEY CHISHOLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DT
Contact information
Practice address
636 BROADWAY ST NE, MINNEAPOLIS, MN 55413-2164
(612) 746-1530
Mailing address
636 BROADWAY ST NE, MINNEAPOLIS, MN 55413-2164
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1700941218
MN
Other
Enumeration date
12/27/2023
Last updated
12/27/2023
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