Organization
TRACY M. ST. DENNIS, D.D.S., PLLC
Active
Other names
Willow Lake Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MARK ST DENNIS (GENERAL MANAGER)
(651) 341-2106
Entity
Organization
Contact information
Practice address
3475 WILLOW LAKE BLVD, SUITE 100, VADNAIS HEIGHTS, MN 55110-5156
(651) 341-2106
Mailing address
3475 WILLOW LAKE BLVD, SUITE 100, VADNAIS HEIGHTS, MN 55110-5156
(651) 341-2106
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/28/2016
Last updated
10/28/2016
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