Provider Demographics
NPI:1891018842
Name:MENON, HEMA V (BDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:HEMA
Middle Name:V
Last Name:MENON
Suffix:
Gender:F
Credentials:BDS, MSD
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Other - Credentials:
Mailing Address - Street 1:393 DUNLAP ST N
Mailing Address - Street 2:CENTRAL MEDICAL BUILDING, SUITE #100
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4200
Mailing Address - Country:US
Mailing Address - Phone:651-646-1318
Mailing Address - Fax:651-642-2592
Practice Address - Street 1:393 DUNLAP ST N
Practice Address - Street 2:CENTRAL MEDICAL BUILDING, SUITE #100
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4200
Practice Address - Country:US
Practice Address - Phone:651-646-1318
Practice Address - Fax:651-642-2592
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNS301223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics