Individual
KAITLYN JEAN NIEMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH, DT
Contact information
Practice address
636 BROADWAY ST NE, MINNEAPOLIS, MN 55413-2164
(612) 746-1530
Mailing address
6478 STILLWATER BLVD N, OAKDALE, MN 55128-3716
(612) 875-4522
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
11634
MN
125J00000X
Dental Therapist
Primary
DT175
MN
Other
Enumeration date
04/04/2024
Last updated
10/15/2024
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