Individual
JAGADISH MARAHATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
512 66TH AVE N, BROOKLYN CENTER, MN 55430-1643
(763) 560-3334
Mailing address
1014 27TH AVE SE APT B, MINNEAPOLIS, MN 55414-2757
(612) 916-0946
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D13819
MN
Other
Enumeration date
06/02/2017
Last updated
07/21/2022
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