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PHONSUDA CHANTHAVISOUK RDH, MDT
NPI 1548844053
Dental Therapist in Minneapolis, MN

Active since May 11, 2021
728 E HENNEPIN AVE, MINNEAPOLIS, MN 55414(612) 746-1530 Get Directions Write a Review

NPPES record last updated: August 8, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Aug 8, 2023, Jul 21, 2021, May 11, 2021 (3 updates tracked since 2021).

About Phonsuda Chanthavisouk Rdh, Mdt NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PHONSUDA CHANTHAVISOUK RDH, MDT (NPI 1548844053) is an individual dental therapist in Minneapolis, Minnesota, licensed in Minnesota (DT137) and active in the NPI registry since May 2021.

NPPES Registry Identity

NPI1548844053
Entity TypeIndividualFemale
Primary Taxonomy125J00000X
Provider Legal NamePHONSUDA CHANTHAVISOUKCredential: RDH, MDT
Location Address728 E HENNEPIN AVEMinneapolis, MN 55414-1126
Mailing Address6145 14th Ave SMinneapolis, MN 55423-1728 · (612) 961-9886
Phone(612) 746-1530
Sole ProprietorNo
Enumeration DateMay 11, 2021
Last NPPES UpdateAugust 8, 20233 updates tracked since enumeration
NPPES CertifiedAugust 8, 2023
✔ NPI 1548844053 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDental TherapistDental Providers
Taxonomy Code125J00000X
License✔ Licensed in MN · DT137
Definition

A Dental Therapist is an individual who has completed an accredited or non-accredited dental therapy program and who has been authorized by the relevant state board or a tribal entity to provide services within the scope of their practice under the supervision of a dentist. Functions that may be delegated to the dental therapist vary based on the needs of the dentist, the educational preparation of the dental therapist and state dental practice acts and regulations.

Also ListedDental HygienistTaxonomy 124Q00000X · License H11002 (MN)
728 E HENNEPIN AVE, Minneapolis, MN 55414
Open in Google Maps ↗

Other Identifiers 1

MedicaidDT137MN

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CHEE LOR DENTAL THERAPIST
Dental Therapist
728 E HENNEPIN AVE
MINNEAPOLIS, MN 55414
Hennepin County (612) 746-1530

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Phonsuda Chanthavisouk's NPI number?

The NPI number for Phonsuda Chanthavisouk is 1548844053. It was assigned to this individual provider in the NPPES registry on May 11, 2021.

Where is Phonsuda Chanthavisouk located?

Phonsuda Chanthavisouk practices at 728 E Hennepin Ave, Minneapolis, MN 55414. The listed phone number is (612) 746-1530.

What is Phonsuda Chanthavisouk's specialty?

The primary specialty registered for this NPI is Dental Therapist with taxonomy code 125J00000X.

When was this NPI record last updated?

The NPPES record for Phonsuda Chanthavisouk was last updated on August 8, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.