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General NPI Number Information
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NPI Number | 1134327273
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Entity Type | Individual
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Provider Name | THERESA L. JUHLIN D.D.S., M.S.
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Gender | Female
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 12/09/2020
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Provider Practice Location Address
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Address Line | 1835 COUNTY ROAD C W STE 290
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City | ROSEVILLE
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State | MN
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Zip | 55113-1343
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Country | US
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Telephone | 651-925-4177
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 COUNTY ROAD C W STE 2210
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City | ROSEVILLE
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State | MN
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Zip | 55113-2551
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Country | US
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Telephone | 651-633-0500
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | S98
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License Number State | MN
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