Individual
SOPHANA JAYAKUMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MDS, DDS
Contact information
Practice address
11237 FOLEY BLVD NW, COON RAPIDS, MN 55448-3389
(763) 757-1234
Mailing address
19984 62ND PL, CORCORAN, MN 55340
(612) 986-7544
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
15323
MN
Other
Enumeration date
07/24/2025
Last updated
07/24/2025
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