Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Phonsuda Chanthavisouk, RDH, MDT

Individual provider Dental Therapist · NPI 1548844053

Phonsuda Chanthavisouk, RDH, MDT is a Dental Therapist in Minneapolis, Minnesota. Licensed in Minnesota. Registered with an NPI since 2021.

Licensed in
MN
In the registry since
2021
Specialties on file
2
What do these letters mean?
RDH — Registered Dental Hygienist
A licensed hygienist who cleans teeth and screens for oral disease.

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Practice location Address checks out

728 E Hennepin Ave
Minneapolis, MN 55414-1126
Phone: (612) 746-1530
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dental Therapist (primary) Taxonomy 125J00000X · Licence DT137 (MN)
Dental Hygienist Taxonomy 124Q00000X · Licence H11002 (MN)

Record details

NPI number1548844053
Entity typeIndividual (Type 1)
GenderFemale
Credentials RDH , MDT
Sole proprietorNo
NPI enumeratedMay 11, 2021
Last updated in NPPESAugust 8, 2023
Certification dateAugust 8, 2023
Mailing address6145 14th Ave S, Minneapolis, MN 55423-1728

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