Basic Information
| Provider Information | |||||||||
| NPI: | 1366600835 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AGRIGOROAE BOLOS | ||||||||
| FirstName: | NICOLETA | ||||||||
| MiddleName: | TEREZIA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17094 72ND PL N | ||||||||
| Address2: | |||||||||
| City: | MAPLE GROVE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553114558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7638983608 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4243 4TH AVE S | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554092113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128229030 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2008 | ||||||||
| LastUpdateDate: | 03/04/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 8563 | NC | Y | Dental Providers | Dentist |
No ID Information.