Individual
LEAH HILDEBRANDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DENTAL THERAPIST
Contact information
Practice address
111 MAIN ST, PO BOX 40, DEER RIVER, MN 56636
(218) 246-8200
Mailing address
602 REYNOLDS ST, GRAND RAPIDS, MN 55744-3054
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9499
MN
1223G0001X
General Practice Dentistry
D13701
MN
1223G0001X
General Practice Dentistry
D8282
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1275797763
GOVERNMENT
MN
01
—
1619949328
GOVERNMENT
MN
Enumeration date
06/02/2017
Last updated
03/17/2018
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