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Individual

PETRA BACHOUR

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DMD

Contact information

Practice address
515 DELAWARE ST SE, MINNEAPOLIS, MN 55455-0357
(612) 625-6444
Mailing address
515 DELAWARE ST SE, MINNEAPOLIS, MN 55455-0357

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D14253
MN

Other

Enumeration date
06/25/2019
Last updated
06/25/2019
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