Organization
NORTHERN LAKES DENTAL, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT ALAN WAGNILD D. D. S. (PRESIDENT)
(218) 736-4000
Entity
Organization
Contact information
Practice address
1108 WESTERN AVE, FERGUS FALLS, MN 56537-4808
(218) 736-4000
(218) 736-0766
Mailing address
1108 WESTERN AVE, FERGUS FALLS, MN 56537-4808
(218) 736-4000
(218) 736-0766
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10677
MN
Other
Enumeration date
04/24/2007
Last updated
08/22/2020
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