Organization
WHITE BEAR LAKE ORTHODONTICS
Active
Organization
WHITE BEAR LAKE ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMARA SMITH DDS, MSD (OWNER/ORTHODONTIST)
(763) 999-0055
Entity
Organization
Contact information
Practice address
4437 LAKE AVE S, WHITE BEAR LAKE, MN 55110-3455
(763) 999-0055
Mailing address
4437 LAKE AVE S, WHITE BEAR LAKE, MN 55110-3455
(763) 999-0055
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376821157
—
MN
Enumeration date
11/17/2020
Last updated
11/17/2020
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