Individual
BAO SHIRLEY THAO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
701 25TH AVE S STE 400, MINNEAPOLIS, MN 55454-1443
(916) 281-6067
Mailing address
6445 LYNDALE AVE S APT 513, RICHFIELD, MN 55423-7569
(916) 281-6067
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D15052
MN
Other
Enumeration date
05/28/2024
Last updated
05/28/2024
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