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General NPI Number Information
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NPI Number | 1083703995
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Entity Type | Individual
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Provider Name | JOHN DAVID MIETTUNEN DDS
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 704 E HOWARD ST
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City | HIBBING
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State | MN
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Zip | 55746-1744
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Country | US
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Telephone | 218-262-4551
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Fax |
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Provider Business Mailing Address
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Address Line | 506 OPAL LN
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City | HIBBING
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State | MN
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Zip | 55746-3846
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Country | US
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Telephone | 218-263-3041
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8967
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License Number State | MN
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