Organization
LAKESIDE DENTAL ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TODD HANSEN DDS (PRESIDENT)
(218) 525-1958
Entity
Organization
Contact information
Practice address
5331 E SUPERIOR ST, DULUTH, MN 55804-2423
(218) 525-1958
(218) 525-9219
Mailing address
5331 E SUPERIOR ST, DULUTH, MN 55804-2423
(218) 525-1958
(218) 525-9219
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D11088
MN
Other
Enumeration date
11/13/2006
Last updated
08/22/2020
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