Organization
WARROAD FAMILY DENTISTRY, LTD
Active
Other names
Lake Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY ANN THIELE (CORPORATE SECRETARY)
(218) 386-1048
Entity
Organization
Contact information
Practice address
307 SOUTH STATE AVE, WARROAD, MN 56763-0490
(218) 386-1048
(218) 386-1049
Mailing address
PO BOX 490, WARROAD, MN 56763-0490
(218) 386-1048
(218) 386-1049
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9514
MN
Other
Enumeration date
10/21/2005
Last updated
08/22/2020
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