Provider Demographics
NPI:1619532991
Name:GRISHINA, DARIA ALEKSEYEVNA (DDS)
Entity Type:Individual
Prefix:
First Name:DARIA
Middle Name:ALEKSEYEVNA
Last Name:GRISHINA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2732 GRAND AVE S APT 102
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1415
Mailing Address - Country:US
Mailing Address - Phone:612-889-8611
Mailing Address - Fax:
Practice Address - Street 1:1963 ROBERT ST S STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-3942
Practice Address - Country:US
Practice Address - Phone:651-724-9689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND141721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice