# BLOOMINGTON LAKE DENTAL CLINIC PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861587842
- **Authorized official:** MRS. SAUNDRA ANN ROHRER (MANAGER)
- **Authorized official phone:** (612) 729-2393

## Contact information

- **Practice address:** 3042 BLOOMINGTON AVE, MINNEAPOLIS, MN 55407-1716
- **Practice address phone:** (612) 729-2393
- **Practice address fax:** (612) 729-2395
- **Mailing address:** 3042 BLOOMINGTON AVE, MINNEAPOLIS, MN 55407-1716
- **Mailing address phone:** (612) 729-2393
- **Mailing address fax:** (612) 729-2395

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D11528 | MN | Yes |

## Other

- **Enumeration date:** 10/04/2006
- **Last updated:** 08/22/2020