Organization
GREAT LAKES ENDODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK TERRANCE PHILLIPS DDS (DENTIST)
(651) 528-0240
Entity
Organization
Contact information
Practice address
4815 W ARROWHEAD RD, HERMANTOWN, MN 55811-4004
(218) 772-0772
Mailing address
4815 W ARROWHEAD RD, HERMANTOWN, MN 55811-4004
(218) 772-0772
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D12534
MN
Other
Enumeration date
11/07/2013
Last updated
11/07/2013
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