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Individual

NICOLETTE GENGEL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1384 109TH AVE NE STE 200, BLAINE, MN 55434
(763) 757-6000
Mailing address
112 LAKE DR S, NEW FAIRFIELD, CT 06812-3505

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D14088
MN

Other

Enumeration date
05/15/2017
Last updated
07/16/2018
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