Organization
CITY OF LAKES DENTAL, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HERBERT WILLIAM SCHULTE D.D.S. (PRESIDENT)
(612) 823-1816
Entity
Organization
Contact information
Practice address
5524 NICOLLET AVE, MINNEAPOLIS, MN 55419-1930
(612) 823-1816
(612) 823-5955
Mailing address
5524 NICOLLET AVE, MINNEAPOLIS, MN 55419-1930
(612) 823-1816
(612) 823-5955
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D8428
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40 06726
BLUE
MN
Enumeration date
11/20/2006
Last updated
08/22/2020
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