| Chicago Lake Dental | |
|
2900 Chicago Ave Minneapolis MN 55407-1322 | |
| (612) 823-2080 | |
| (612) 823-5777 |
| Full Name | Chicago Lake Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2900 Chicago Ave, Minneapolis, Minnesota |
| Authorized Official Name and Position | David William Johnson (OWNER) |
| Authorized Official Contact | 6128232080 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Chicago Lake Dental 2900 Chicago Ave Minneapolis MN 55407-1322 Ph: (612) 823-2080 | Chicago Lake Dental 2900 Chicago Ave Minneapolis MN 55407-1322 Ph: (612) 823-2080 |
| NPI Number | 1497936389 |
|---|---|
| Provider Enumeration Date | 11/19/2007 |
| Last Update Date | 11/19/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497936389 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D9512 (Minnesota) | Primary |
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