Organization
RICE LAKE DENTAL, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DARREL HOWARD JOHNSRUD DDS (PRESIDENT)
(612) 385-6718
Entity
Organization
Contact information
Practice address
13998 MAPLE KNOLL WAY STE 100, MAPLE GROVE, MN 55369-7004
(763) 420-5599
(763) 416-4771
Mailing address
13998 MAPLE KNOLL WAY STE 100, MAPLE GROVE, MN 55369-7004
(763) 420-5599
(763) 416-4771
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/04/2022
Last updated
10/04/2022
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