Organization
LAKE STREET FAMILY DENTAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN NELSON HOLCOMBE DMD (PRESIDENT)
(763) 350-6234
Entity
Organization
Contact information
Practice address
119 LAKE ST S, SUITE 1, MORA, MN 55051-1576
(320) 679-2435
Mailing address
10799 251ST AVE NW, ZIMMERMAN, MN 55398-4558
(763) 350-6234
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D13567
MN
Other
Enumeration date
06/25/2015
Last updated
06/25/2015
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