Organization
EAGLE LAKE FAMILY DENTISTRY, PA
Active
Parent organization
EAGLE LAKE FAMILY DENTISTRY, PA
Other names
St. James Family Dentistry
Organization subpart
Yes
Provider details
NPI number
Legal business name
EAGLE LAKE FAMILY DENTISTRY, PA
Authorized official
DR. SEAN PATRICK VOSTAD DDS (DENTIST)
(507) 257-3800
Entity
Organization
Contact information
Practice address
504 2ND AVE S, SAINT JAMES, MN 56081-1737
(507) 375-4611
(507) 375-4989
Mailing address
504 2ND AVE S, PO BOX 515, SAINT JAMES, MN 56081-1737
(507) 375-4611
(507) 375-4989
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D11770
MN
122300000X
Dentist
D12980
MN
122300000X
Dentist
Primary
D9088
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1245529650
NPI
MN
01
—
1528138948
NPI
MN
01
—
1649340050
NPI
MN
01
—
1770653446
NPI
MN
Enumeration date
08/02/2011
Last updated
08/02/2011
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