Organization
WEST LAKES DENTISTRY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE MINER (OWNER)
(952) 472-7717
Entity
Organization
Contact information
Practice address
5205 SHORELINE DR, MOUND, MN 55364-1770
(952) 472-7717
Mailing address
5205 SHORELINE DR, MOUND, MN 55364-1770
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D11974
MN
Other
Enumeration date
02/03/2016
Last updated
02/03/2016
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