Individual
POURNAWATTIE ANDREA CHANDRADATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
7936 PORTLAND AVE S, BLOOMINGTON, MN 55420-1315
(763) 600-8613
Mailing address
15769 WYOMING AVE, SAVAGE, MN 55378-6627
(612) 803-7113
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D14249
MN
Other
Enumeration date
06/07/2019
Last updated
06/07/2019
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