Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | D13566 | MN |
NPI | 1164804548 |
---|---|
Provider Name | Erika Guetter |
First Address | Detroit Lakes, MN 56501-7739 |
Second Address | Fargo, ND 58102-4835 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2015 |
Last Update Date | 23/06/2015 |