Organization
HAM LAKE DENTAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELE MARIE REVOIR DDS (DENTIST)
(763) 434-4188
Entity
Organization
Contact information
Practice address
17565 CENTRAL AVE NE, HAM LAKE, MN 55304
(763) 434-4188
(763) 413-7261
Mailing address
17565 CENTRAL AVE NE, HAM LAKE, MN 55304
(763) 434-4188
(763) 413-7261
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
D10416
MN
1223G0001X
General Practice Dentistry
D10544
MN
1223G0001X
General Practice Dentistry
Primary
D9362
MN
1223G0001X
General Practice Dentistry
D9466
MN
Other
Enumeration date
11/03/2006
Last updated
08/22/2020
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