Organization
FOREST LAKE ENDODONTICS
Active
Other names
Forest Lake Endodontics
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE IRENE KLOSSNER (OFFICE MANAGER)
(651) 464-9888
Entity
Organization
Contact information
Practice address
1420 LAKE ST S STE 200, FOREST LAKE, MN 55025-2713
(651) 464-9888
Mailing address
1420 LAKE ST S STE 200, FOREST LAKE, MN 55025-2713
(651) 464-9888
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
—
—
Other
Enumeration date
08/25/2020
Last updated
09/08/2020
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