Organization
GLEN LAKE DENTAL ASSOCIATES, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENT CASSIDY D.D.S. (PRESIDENT)
(952) 935-5212
Entity
Organization
Contact information
Practice address
14418 EXCELSIOR BLVD, MINNETONKA, MN 55345-5820
(952) 935-5212
(952) 935-1391
Mailing address
14418 EXCELSIOR BLVD, MINNETONKA, MN 55345-5820
(952) 935-5212
(952) 935-1391
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D9306
MN
Other
Enumeration date
08/11/2008
Last updated
08/11/2008
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