Organization
INTERLACHEN DENTAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN LIBERKO DDS (OWNER)
(952) 920-9579
Entity
Organization
Contact information
Practice address
5101 VERNON AVE S, STE 1B, EDINA, MN 55436-2171
(952) 920-9579
(952) 920-9298
Mailing address
5101 VERNON AVE S, STE 1B, EDINA, MN 55436-2171
(952) 920-9579
(952) 920-9298
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
04/26/2023
Last updated
04/26/2023
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