Individual
JEREMY DERKSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
185 MCCARRONS BLVD N #316, ROSEVILLE, MN 55113
(515) 326-5977
Mailing address
185 MCCARRONS BLVD N #316, ROSEVILLE, MN 55113
(515) 326-5977
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D12937
MN
Other
Enumeration date
05/27/2011
Last updated
05/27/2011
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