Organization
FOUNTAIN LAKE FAMILY DENTAL
Active
Other names
Fountain Lake Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
KARISA LEHMANN (OFFICE MANAGER)
(507) 373-3323
Entity
Organization
Contact information
Practice address
146 W CLARK ST, ALBERT LEA, MN 56007-2546
(507) 373-3323
(507) 373-4513
Mailing address
146 W CLARK ST, ALBERT LEA, MN 56007-2546
(507) 373-3323
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D13630
MINNESOTA
MN
Enumeration date
07/30/2020
Last updated
07/30/2020
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