Healthcare Provider Details

I. General information

NPI: 1215772025
Provider Name (Legal Business Name): MINH TU DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11231 AQUILA DR N
CHAMPLIN MN
55316-2096
US

IV. Provider business mailing address

6263 NATHAN LN N
MAPLE GROVE MN
55369-6284
US

V. Phone/Fax

Practice location:
  • Phone: 763-275-1318
  • Fax:
Mailing address:
  • Phone: 952-300-0507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD15506
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: