| Birch Lake Dental | |
|
4641 White Bear Pkwy White Bear Lake MN 55110-3300 | |
| (651) 429-0404 | |
| Not Available |
| Full Name | Birch Lake Dental |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4641 White Bear Pkwy, White Bear Lake, Minnesota |
| Authorized Official Name and Position | Geetha J Damodaran (OWNER) |
| Authorized Official Contact | 6514290404 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Birch Lake Dental 4641 White Bear Pkwy White Bear Lake MN 55110-3300 Ph: (651) 429-0404 | Birch Lake Dental 4641 White Bear Pkwy White Bear Lake MN 55110-3300 Ph: (651) 429-0404 |
| NPI Number | 1922619162 |
|---|---|
| Provider Enumeration Date | 08/12/2020 |
| Last Update Date | 08/12/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922619162 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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