Individual
MRS. MADISON RAE DICKOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
2056 SUPERIOR DR NW, ROCHESTER, MN 55901-5024
(507) 315-4015
Mailing address
16299 STEMMER RIDGE RD NW, SHAKOPEE, MN 55379-9476
(952) 797-3238
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D14584
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/10/2021
Last updated
01/26/2022
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