Organization
EAGLE LAKE FAMILY DENTISTRY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY ALLAN HOLMBERG BS, DDS (PRESIDENT)
(507) 257-3800
Entity
Organization
Contact information
Practice address
104 PLAINVIEW STREET, BOX 97, EAGLE LAKE, MN 56024
(507) 257-3800
(507) 257-3456
Mailing address
104 PLAINVIEW STREET, BOX 97, EAGLE LAKE, MN 56024
(507) 257-3800
(507) 257-3456
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
MN
Other
Enumeration date
11/09/2006
Last updated
02/09/2016
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