Organization
ISLA PLLC
Active
Other names
Washington Square Dental
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY ANDERSON (DIRECTOR)
(651) 353-6652
Entity
Organization
Contact information
Practice address
4754 WASHINGTON SQ, WHITE BEAR LAKE, MN 55110-3257
(651) 353-6652
Mailing address
7810 SAINT CROIX TRAIL LN S, HASTINGS, MN 55033-9737
(651) 353-6652
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/25/2019
Last updated
10/25/2019
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