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General NPI Number Information
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NPI Number | 1093698573
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Entity Type | Individual
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Provider Name | ROBERTA SANTOS SOUZA DIAS DDS
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Gender | Female
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Dates
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Enumeration Date | 07/30/2025
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 320 W MYRTLE ST STE 100
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City | DULUTH
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State | MN
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Zip | 55811-4457
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Country | US
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Telephone | 218-491-8058
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Fax |
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Provider Business Mailing Address
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Address Line | 3120 NORTHDALE BLVD NW UNIT 427
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City | COON RAPIDS
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State | MN
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Zip | 55433-3020
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Country | US
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Telephone | 651-342-3678
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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 | D15335
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License Number State | MN
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