Organization
CHISAGO LAKES DENTAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL HURSH DDS (OWNER)
(763) 360-1465
Entity
Organization
Contact information
Practice address
12745 N 1ST AVE, LINDSTROM, MN 55045-9585
(763) 360-1465
Mailing address
12745 N 1ST AVE, P. O. BOX 39, LINDSTROM, MN 55045-9585
(763) 360-1465
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8021
MN
Other
Enumeration date
08/07/2014
Last updated
08/07/2014
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