Organization
FIVE LAKES DENTAL STUDIO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY JOSEPH STAUFFER CDT (OWNER/CERAMIST)
(507) 235-9040
Entity
Organization
Contact information
Practice address
31 DOWNTOWN PLZ, FAIRMONT, MN 56031-1702
(507) 235-9040
Mailing address
31 DOWNTOWN PLZ, FAIRMONT, MN 56031-1702
(507) 235-9040
Taxonomy
Speciality
Code
Description
License number
State
292200000X
Dental Laboratory
Primary
—
—
Other
Enumeration date
06/17/2026
Last updated
06/17/2026
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