Organization
BOREALIS DENTAL STUDIO, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BECKY GOOLSBY (BUSINESS MANAGER)
(405) 837-3159
Entity
Organization
Contact information
Practice address
12745 N 1ST AVE, LINDSTROM, MN 55045-9585
(651) 257-2720
Mailing address
6892 256TH ST, WYOMING, MN 55092-8362
(405) 837-3159
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D13152
MN
Other
Enumeration date
07/06/2016
Last updated
07/06/2016
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