Healthcare Provider Details

I. General information

NPI: 1164086807
Provider Name (Legal Business Name): NIMA IBRAHIM ODOWA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 CAMPUS DR STE 245
PLYMOUTH MN
55441-2678
US

IV. Provider business mailing address

2805 CAMPUS DR STE 245
PLYMOUTH MN
55441-2678
US

V. Phone/Fax

Practice location:
  • Phone: 763-383-1788
  • Fax:
Mailing address:
  • Phone: 763-383-1788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD14186
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: