Thorn-Black, Hattie L.

Thorn-Black, Hattie L. is an individual health care provider with primary practice located at 1315 E 24Th St , Minneapolis MN 55404-3975. She recently has only one registered license in Dental Providers / Dentist, which is considered as her primary health care specialty. Thorn-Black, Hattie L. can be contacted via phone (612) 721-9825.

Contact Information

Primary practice address
1315 E 24Th St Minneapolis MN 55404-3975
Phone: (612) 721-9825
Fax: (612) 721-2904
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X D8307 Minnesota

Profile Details

NPI number 1215933486
LBN Legal business name Thorn-Black, Hattie L.
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 22nd, 2005
Last updated Oct 1st, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215933486 NPPES
Minnesota MEDICAID 942317600

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