Organization
FALLS COURT DENTISTS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYLE MARK GESSELL DDS (OWNER CORP VICE PRESIDENT)
(320) 632-6621
Entity
Organization
Contact information
Practice address
119 NE FIRST STREET, STE 4, LITTLE FALLS, MN 56345
(320) 632-6621
(320) 632-1829
Mailing address
119 NE FIRST STREET, STE 4, LITTLE FALLS, MN 56345
(320) 632-6621
(320) 632-1829
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1265
HEALTH PARTNERS
—
01
—
812989
UNITED OF CONCORDIA
—
01
—
85320EA
BLUE CROSS BLUE SHIELD
—
Enumeration date
03/08/2006
Last updated
08/22/2020
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