Individual
SAMUAL LEE BACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1905 PLAZA DR, EAGAN, MN 55122-2883
(651) 686-6800
Mailing address
1905 PLAZA DR, EAGAN, MN 55122-2883
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D145759
MN
122300000X
Dentist
Primary
D14759
MN
Other
Enumeration date
06/10/2022
Last updated
06/17/2022
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