Provider Demographics
NPI:1770098550
Name:SLABBER, MILLIE ANN (RDH)
Entity type:Individual
Prefix:MS
First Name:MILLIE
Middle Name:ANN
Last Name:SLABBER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:MILLIE
Other - Middle Name:ANN
Other - Last Name:SLABBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:2246 SACIA LN
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-7222
Mailing Address - Country:US
Mailing Address - Phone:715-965-2354
Mailing Address - Fax:
Practice Address - Street 1:409 DUNLAP ST N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4201
Practice Address - Country:US
Practice Address - Phone:651-290-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH6193124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNMAS16Medicaid
MNH6193Medicaid