Individual
SURABHI PANCHOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2500 COMO AVE, SAINT PAUL, MN 55108-1460
(651) 647-2525
Mailing address
401 1ST AVE NE UNIT 961, MINNEAPOLIS, MN 55413-3171
(614) 634-3521
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
10397
KY
122300000X
Dentist
12013100A
IN
122300000X
Dentist
Primary
D14504
MN
Other
Enumeration date
03/13/2018
Last updated
04/14/2021
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