Individual
KIERSTEN MICAEL BOEHM MASELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
14199 EDGEWOOD DR, BAXTER, MN 56425-8462
(651) 587-6846
Mailing address
2523 MAPLE LN, ROSEVILLE, MN 55113-1013
(651) 587-6846
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D14422
MN
Other
Enumeration date
04/04/2020
Last updated
07/15/2020
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