| Clear Lakes Dental | |
|
555 Wabasha St N Ste 250 Saint Paul MN 55102-1673 | |
| (651) 292-9331 | |
| Not Available |
| Full Name | Clear Lakes Dental |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 555 Wabasha St N Ste 250, Saint Paul, Minnesota |
| Authorized Official Name and Position | David Ji Hyun Park (CEO) |
| Authorized Official Contact | 6512929331 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Clear Lakes Dental 555 Wabasha St N Ste 250 Saint Paul MN 55102-1673 Ph: (651) 292-9331 | Clear Lakes Dental 555 Wabasha St N Ste 250 Saint Paul MN 55102-1673 Ph: (651) 292-9331 |
| NPI Number | 1689181489 |
|---|---|
| Provider Enumeration Date | 01/03/2018 |
| Last Update Date | 01/03/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689181489 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D13905 (Minnesota) | Primary |
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