Organization
LAKEVIEW DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANGIE FAYE WEBB (RECEPTIONIST)
(218) 751-4523
Entity
Organization
Contact information
Practice address
603 BEMIDJI AVE N, BEMIDJI, MN 56601-3015
(218) 751-4523
(218) 751-0285
Mailing address
603 BEMIDJI AVE N, BEMIDJI, MN 56601-3015
(218) 751-4523
(218) 751-0285
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
10118
MN
1223G0001X
General Practice Dentistry
Primary
8362
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1821161910
—
MN
05
—
1962575043
—
MN
Enumeration date
12/21/2009
Last updated
12/21/2009
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