Organization
LAKEVILLE DENTAL ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROSE A HARRISON (MANAGER)
(952) 469-3300
Entity
Organization
Contact information
Practice address
20171 ICENIC TRL, LAKEVILLE, MN 55044-7708
(952) 469-3300
Mailing address
20171 ICENIC TRL, LAKEVILLE, MN 55044-7708
(952) 469-3300
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D12108
MN
Other
Enumeration date
12/16/2010
Last updated
10/17/2011
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