Organization
RKSA DENTAL ENTERPRISES PLLC
Active
Other names
Crystal Lake Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
SAM JACOBSON (BUSINESS MANAGER)
(763) 588-8426
Entity
Organization
Contact information
Practice address
3925 37TH AVE N, ROBBINSDALE, MN 55422-2357
(763) 588-8426
Mailing address
3925 37TH AVE N, ROBBINSDALE, MN 55422-2357
(763) 588-8426
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
09/02/2020
Last updated
09/02/2020
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