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Organization
FOUNTAIN LAKE FAMILY DENTAL
Active
Organization
FOUNTAIN LAKE FAMILY DENTAL
Active
Other names
Fountain Lake Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
KARISA LEHMANN (OFFICE MANAGER)
(507) 373-3323
Entity
Organization
Contact information
Practice address
146 W CLARK ST, ALBERT LEA, MN 56007-2546
(507) 373-3323
(507) 373-4513
Mailing address
146 W CLARK ST, ALBERT LEA, MN 56007-2546
(507) 373-3323
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D13630
MINNESOTA
MN
Enumeration date
07/30/2020
Last updated
07/30/2020
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