Organization
LAKE COUNTY DENTAL LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY JOHN MATTSON DDS (OWNER)
(218) 829-4243
Entity
Organization
Contact information
Practice address
402 JAMES ST, BRAINERD, MN 56401-2965
(218) 829-4243
(218) 825-8102
Mailing address
402 JAMES ST, BRAINERD, MN 56401-2965
(218) 829-4243
(218) 825-8102
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
MATTSON 10813
MN
122300000X
Dentist
Primary
MOEN 9531
MN
Other
Enumeration date
07/29/2005
Last updated
08/22/2020
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