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Organization
BIRCH LAKE DENTAL PA
Active
Organization
BIRCH LAKE DENTAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GEETHA J DAMODARAN D.D.S. (OWNER)
(651) 429-0404
Entity
Organization
Contact information
Practice address
2641 WHITE BEAR PARKWAY, WHITE BEAR LAKE, MN 55110
(651) 429-0404
(651) 429-0472
Mailing address
2641 WHITE BEAR PARKWAY, WHITE BEAR LAKE, MN 55110
(651) 429-0404
(651) 429-0472
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
7712MN
MN
1223G0001X
General Practice Dentistry
Primary
D10949MN
MN
Other
Enumeration date
02/12/2009
Last updated
02/12/2009
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