Healthcare Provider Details

I. General information

NPI: 1003833641
Provider Name (Legal Business Name): STEPHANIE MAZHARI HUANG D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 COUNTY ROAD B W
ROSEVILLE MN
55113-4527
US

IV. Provider business mailing address

708 COUNTY ROAD B WEST
ROSEVILLE MN
55113
US

V. Phone/Fax

Practice location:
  • Phone: 651-489-0161
  • Fax: 651-489-9938
Mailing address:
  • Phone: 651-489-0161
  • Fax: 651-489-9938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD11099
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: