Organization
HEALTH SOURCE DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN GLANCEY CFO (CHIEF FINANCIAL OFFICER)
(651) 539-7200
Entity
Organization
Contact information
Practice address
140 BIRCH ST. N, SUITE 114, CAMBRIDGE, MN 55008
(763) 347-4399
(651) 431-7641
Mailing address
3200 LABORE RD, SUITE 104, VADNAIS HEIGHTS, MN 55110-5186
(651) 539-7200
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
366053200
—
MN
Enumeration date
09/15/2006
Last updated
01/07/2026
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