Phonsuda Chanthavisouk, RDH, MDT
NPI 1548844053ActiveIndividual· Dental Therapist· Minneapolis, MN
Dental Therapist (RDH, MDT) in Minneapolis, Minnesota, licensed in MN, with an NPI issued in May 2021.
Overview
| NPI | 1548844053 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | RDH, MDT |
| Sole proprietor | No |
| NPI issued | May 11, 2021 |
| Last updated in NPPES | Aug 8, 2023 |
| Certified by provider | Aug 8, 2023 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dental Therapist Primary | 125J00000X | DT137 | MN |
| Dental Hygienist | 124Q00000X | H11002 | MN |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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