Healthcare Provider Details

I. General information

NPI: 1851625099
Provider Name (Legal Business Name): ANN TIEU HUA D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13059 RIDGEDALE DR
MINNETONKA MN
55305-1807
US

IV. Provider business mailing address

12017 RIDGEMOUNT AVE N
MINNETONKA MN
55305
US

V. Phone/Fax

Practice location:
  • Phone: 952-545-8603
  • Fax:
Mailing address:
  • Phone: 206-595-2616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE 60117003
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: