| Glen Lake Family Dentistry | |
|
5509 Eden Prairie Road Suite A Minnetonka MN 55345 | |
| (952) 938-6038 | |
| (952) 935-9175 |
| Full Name | Glen Lake Family Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 5509 Eden Prairie Road, Minnetonka, Minnesota |
| Authorized Official Name and Position | Alex Scott (OWNER) |
| Authorized Official Contact | 9529386038 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Glen Lake Family Dentistry 5509 Eden Prairie Road Suite A Minnetonka MN 55345 Ph: (952) 938-6038 | Glen Lake Family Dentistry 5509 Eden Prairie Road Suite A Minnetonka MN 55345 Ph: (952) 938-6038 |
| NPI Number | 1679142673 |
|---|---|
| Provider Enumeration Date | 06/23/2021 |
| Last Update Date | 10/26/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679142673 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
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