Individual
DR. KEVIN DANIEL MOLLDREM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
800 PRAIRIE CENTER DR, SUITE 250, EDEN PRAIRIE, MN 55344-7328
(952) 974-5116
Mailing address
800 PRAIRIE CENTER DR, SUITE 250, EDEN PRAIRIE, MN 55344-7328
(952) 974-5116
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D11329
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1326173279
OFFICE NPI
MN
Enumeration date
04/12/2007
Last updated
07/08/2007
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