Organization
MINNESOTA DENTAL PROFESSIONALS, P.C.
Active
Parent organization
HEARTLAND DENTAL
Other names
Pine Arbor Dental Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
HEARTLAND DENTAL
Authorized official
TABATHA LEMKE (CREDENTIALING COORDINATOR)
(217) 540-6078
Entity
Organization
Contact information
Practice address
6939 PINE ARBOR DR S STE 104, COTTAGE GROVE, MN 55016-4643
(651) 459-3514
Mailing address
6939 PINE ARBOR DR S STE 104, COTTAGE GROVE, MN 55016-4643
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/26/2021
Last updated
05/26/2021
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