Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | R421 | MN |
NPI | 1114154143 |
---|---|
Provider Name | Reda Taleb |
First Address | Minneapolis, MN 55414-3905 |
Second Address | Minneapolis, MN 55455 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2009 |
Last Update Date | 17/06/2009 |