Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | H4474 | MN |
NPI | 1669086716 |
---|---|
Provider Name | Beth Renee Hiner Baribeau |
First Address | New Prague, MN 56071-4159 |
Second Address | Minneapolis, MN 55426-1784 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2020 |
Last Update Date | 06/09/2020 |