Healthcare Provider Details

I. General information

NPI: 1134807779
Provider Name (Legal Business Name): CONNIE SEMI WON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1399 ROBERT ST S
SAINT PAUL MN
55118-3141
US

IV. Provider business mailing address

1399 ROBERT ST S
SAINT PAUL MN
55118-3141
US

V. Phone/Fax

Practice location:
  • Phone: 651-300-1230
  • Fax:
Mailing address:
  • Phone: 651-300-1230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD15533
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: