Organization
LAKE MINNETONKA DENTAL CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE COLE (VP INSURANCE PLAN MANAGEMENT)
(941) 955-3150
Entity
Organization
Contact information
Practice address
109 BUSHAWAY RD STE 300, WAYZATA, MN 55391-2079
(952) 475-0225
Mailing address
109 BUSHAWAY RD STE 300, WAYZATA, MN 55391-2079
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
04/22/2019
Last updated
04/22/2019
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