Organization
CHICAGO LAKE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID WILLIAM JOHNSON JR. DDS (OWNER)
(612) 823-2080
Entity
Organization
Contact information
Practice address
2900 CHICAGO AVE, MINNEAPOLIS, MN 55407-1322
(612) 823-2080
(612) 823-5777
Mailing address
2900 CHICAGO AVE, MINNEAPOLIS, MN 55407-1322
(612) 823-2080
(612) 823-5777
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D9512
MN
Other
Enumeration date
11/19/2007
Last updated
11/19/2007
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