Organization
PEDIATRIC DENTISTRY P.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LILIANA LUCAS (DENTIST)
(320) 229-2222
Entity
Organization
Contact information
Practice address
151 19TH ST S, SARTELL, MN 56377-2153
(320) 229-2222
(888) 563-2069
Mailing address
151 19TH ST S, SARTELL, MN 56377-2153
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
D12249
MN
1223P0221X
Pediatric Dentistry
Primary
D12500
MN
Other
Enumeration date
10/31/2012
Last updated
10/31/2012
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