Organization
FOREST LAKE SMILES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH BURT (DIRECTOR OF OPERATIONS)
(651) 243-5999
Entity
Organization
Contact information
Practice address
1068 LAKE ST S, FOREST LAKE, MN 55025-2639
(651) 464-8207
Mailing address
PO BOX 220, NORTH BRANCH, MN 55056-0220
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
04/11/2019
Last updated
04/11/2019
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