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Organization
EAGLE LAKE FAMILY DENTISTRY, P.A.
Active
Organization
EAGLE LAKE FAMILY DENTISTRY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY ALLAN HOLMBERG BS, DDS (PRESIDENT)
(507) 257-3800
Entity
Organization
Contact information
Practice address
104 PLAINVIEW STREET, BOX 97, EAGLE LAKE, MN 56024
(507) 257-3800
(507) 257-3456
Mailing address
104 PLAINVIEW STREET, BOX 97, EAGLE LAKE, MN 56024
(507) 257-3800
(507) 257-3456
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
MN
Other
Enumeration date
11/09/2006
Last updated
02/09/2016
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