Individual
MINA SAMY BOULOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
470 HIGHWAY 96 W STE 200, SHOREVIEW, MN 55126-3214
(651) 366-6880
(651) 366-6880
Mailing address
7702 NARCISSUS LN N, MAPLE GROVE, MN 55311-1849
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D15431
MN
Other
Enumeration date
05/21/2026
Last updated
05/21/2026
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