Provider Demographics
NPI:1134807043
Name:FERMIN, PAOLA VALENTINA
Entity type:Individual
Prefix:
First Name:PAOLA
Middle Name:VALENTINA
Last Name:FERMIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 26TH AVE SE UNIT 328
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-4324
Mailing Address - Country:US
Mailing Address - Phone:312-866-6275
Mailing Address - Fax:
Practice Address - Street 1:8454 HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-3900
Practice Address - Country:US
Practice Address - Phone:952-933-3667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND149701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice