Organization
CENTRAL LAKES COMMUNITY DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN GLANCEY (CHIEF FINANCIAL OFFICER)
(651) 539-7200
Entity
Organization
Contact information
Practice address
11600 STATE AVE., SUITE A, BRAINERD, MN 56401
(218) 855-8600
(651) 431-7355
Mailing address
3200 LABORE RD., SUITE 104, VADNAIS HEIGHTS, MN 55110-5186
(651) 539-7200
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
970826000
—
MN
Enumeration date
01/26/2007
Last updated
01/07/2026
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