Organization
RIVERSIDE DENTAL CARE,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHELLE DENISE LUND D.D.S. (OWNER)
(507) 931-5646
Entity
Organization
Contact information
Practice address
217 NASSAU ST, SAINT PETER, MN 56082-2055
(507) 931-5646
(507) 934-0148
Mailing address
217 NASSAU ST, SAINT PETER, MN 56082-2055
(507) 931-5646
(507) 934-0148
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
J33063DAH
BCBS MEDICAL ID NUMBER
MN
Enumeration date
11/01/2006
Last updated
08/22/2020
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