Organization
GLACIER LAKE DENTAL P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRACY LU GRASDAL DDS (PRESIDENT)
(952) 486-2595
Entity
Organization
Contact information
Practice address
10450 185TH ST W STE 500, LAKEVILLE, MN 55044-6690
(952) 435-9888
(952) 435-9820
Mailing address
10450 185TH ST W STE 500, LAKEVILLE, MN 55044-6690
(952) 435-9888
(952) 435-9820
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
09/21/2019
Last updated
09/21/2019
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