Organization
LONG LAKE FAMILY DENISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HOSSEIN A JALALI DDS (OWNER)
(651) 633-1311
Entity
Organization
Contact information
Practice address
991 9TH AVE NW, NEW BRIGHTON, MN 55112-2665
(651) 633-1311
(651) 633-4339
Mailing address
991 9TH AVE NW, NEW BRIGHTON, MN 55112-2665
(651) 633-1311
(651) 633-4339
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10256
MN
1223G0001X
General Practice Dentistry
D13480
MN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
10465
MN
Other
Enumeration date
04/27/2016
Last updated
04/27/2016
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