Organization
LAKE AREA DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORDAN DITTBERNER DDS (DENTIST)
(651) 308-1177
Entity
Organization
Contact information
Practice address
4801 HIGHWAY 61 N STE 301, WHITE BEAR LAKE, MN 55110-2753
(651) 762-8474
Mailing address
140 WILDWOOD CT, MAHTOMEDI, MN 55115-4200
(651) 308-1177
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
12/05/2024
Last updated
12/05/2024
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