Organization
LAKE SUPERIOR DENTAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT G RYAN DDS (PARTNER)
(218) 728-6445
Entity
Organization
Contact information
Practice address
1225 E 1ST ST, DULUTH, MN 55805-2402
(218) 728-6445
(218) 724-7003
Mailing address
1225 E 1ST ST, DULUTH, MN 55805-2402
(218) 728-6445
(218) 724-7003
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7B014FO
BCBS MN
MN
01
—
820436
UNITED CONCORDIA
MN
Enumeration date
11/03/2006
Last updated
10/30/2007
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