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Organization
FALLS COURT DENTISTS PA
Active
Organization
FALLS COURT DENTISTS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYLE MARK GESSELL DDS (OWNER CORP VICE PRESIDENT)
(320) 632-6621
Entity
Organization
Contact information
Practice address
119 NE FIRST STREET, STE 4, LITTLE FALLS, MN 56345
(320) 632-6621
(320) 632-1829
Mailing address
119 NE FIRST STREET, STE 4, LITTLE FALLS, MN 56345
(320) 632-6621
(320) 632-1829
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1265
HEALTH PARTNERS
—
01
—
812989
UNITED OF CONCORDIA
—
01
—
85320EA
BLUE CROSS BLUE SHIELD
—
Enumeration date
03/08/2006
Last updated
08/22/2020
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