Provider Demographics
NPI:1851800429
Name:AYMOND, THERESA MARIE (DT)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:AYMOND
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 LYNDALE AVE S STE 230
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2479
Mailing Address - Country:US
Mailing Address - Phone:612-866-1234
Mailing Address - Fax:
Practice Address - Street 1:6601 LYNDALE AVE S STE 230
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2479
Practice Address - Country:US
Practice Address - Phone:612-866-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDT76125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist