Provider Demographics
NPI:1891848362
Name:PARISEAU, MARY J (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:J
Last Name:PARISEAU
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 1:1975 11TH AVE E
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-5148
Mailing Address - Country:US
Mailing Address - Phone:651-770-2900
Mailing Address - Fax:651-770-1014
Practice Address - Street 1:1975 11TH AVE E
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-5148
Practice Address - Country:US
Practice Address - Phone:651-770-2900
Practice Address - Fax:651-770-1014
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND97021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice