Organization
INTERLACHEN DENTAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL JOHN GITZEN DDS (PRESIDENT OWNER DOCTOR)
(952) 920-9579
Entity
Organization
Contact information
Practice address
5101 VERNON AVENUE, SUITE 1B, EDINA, MN 55436
(952) 920-9579
(952) 920-9298
Mailing address
5101 VERNON AVENUE, SUITE 1B, EDINA, MN 55436
(952) 920-9579
(952) 920-9298
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
11/01/2006
Last updated
01/12/2012
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