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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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