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Organization
TRACY M. ST. DENNIS, D.D.S., PLLC
Active
Organization
TRACY M. ST. DENNIS, D.D.S., PLLC
Active
Other names
Willow Lake Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MARK ST DENNIS (GENERAL MANAGER)
(651) 341-2106
Entity
Organization
Contact information
Practice address
3475 WILLOW LAKE BLVD, SUITE 100, VADNAIS HEIGHTS, MN 55110-5156
(651) 341-2106
Mailing address
3475 WILLOW LAKE BLVD, SUITE 100, VADNAIS HEIGHTS, MN 55110-5156
(651) 341-2106
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/28/2016
Last updated
10/28/2016
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