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General NPI Number Information
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NPI Number | 1861180929
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Entity Type | Individual
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Provider Name | ASMITA POUDEL
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Gender | Female
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Dates
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Enumeration Date | 04/26/2023
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 1132 LARPENTEUR AVE W
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City | SAINT PAUL
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State | MN
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Zip | 55113-6317
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Country | US
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Telephone | 651-504-8464
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Fax |
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Provider Business Mailing Address
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Address Line | 4525 43RD AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55406-4016
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Country | US
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Telephone | 571-213-2969
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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 | D15210
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License Number State | MN
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