Organization
LAKEVILLE MODERN DENTISTRY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC M BENDER DMD (PRESIDENT)
(920) 723-8420
Entity
Organization
Contact information
Practice address
17746 KENWOOD TRL, LAKEVILLE, MN 55044-9454
(920) 723-8420
Mailing address
17746 KENWOOD TRL, LAKEVILLE, MN 55044-9454
(952) 388-1778
(952) 388-1763
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194394288
NPI TYPE I
—
Enumeration date
02/20/2023
Last updated
04/22/2023
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