Organization
G2 DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TRACEY M KOCH (OFFICE MANAGER)
(651) 464-2248
Entity
Organization
Contact information
Practice address
1068 LAKE ST S, #209, FOREST LAKE, MN 55025-2639
(651) 464-2248
(651) 464-7944
Mailing address
1068 LAKE ST S, #209, FOREST LAKE, MN 55025-2639
(651) 464-2248
(651) 464-7944
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
11691
MN
122300000X
Dentist
Primary
8009
MN
122300000X
Dentist
8109
MN
122300000X
Dentist
9975
MN
Other
Enumeration date
11/03/2005
Last updated
08/22/2020
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