Chanthavisouk, Phonsuda

Chanthavisouk, Phonsuda is an individual health care provider with primary practice located at 728 E Hennepin Ave , Minneapolis MN 55414-1126. She recently has 2 registered licenses in different health care specialties including Dental Providers / Dental Therapist, Dental Providers / Dental Hygienist. Dental Providers / Dental Therapist is her primary health care specialty. Chanthavisouk, Phonsuda can be contacted via phone (612) 746-1530.

Contact Information

Primary practice address
728 E Hennepin Ave Minneapolis MN 55414-1126
Phone: (612) 746-1530
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dental Therapist 125J00000X DT137 Minnesota
Dental Providers / Dental Hygienist 124Q00000X H11002 Minnesota

Profile Details

NPI number 1548844053
LBN Legal business name Chanthavisouk, Phonsuda
Credentials RDH, MDT
Entity Individual
Sole proprietor 1 No
Enumeration date May 11th, 2021
Last updated Aug 8th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1548844053 NPPES
Minnesota MEDICAID DT137

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