| Glacier Lake Dental P A | |
|
10450 185th St W Ste 500 Lakeville MN 55044-6690 | |
| (952) 435-9888 | |
| (952) 435-9820 |
| Full Name | Glacier Lake Dental P A |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 10450 185th St W Ste 500, Lakeville, Minnesota |
| Authorized Official Name and Position | Tracy Lu Grasdal (PRESIDENT) |
| Authorized Official Contact | 9524862595 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Glacier Lake Dental P A 10450 185th St W Ste 500 Lakeville MN 55044-6690 Ph: (952) 435-9888 | Glacier Lake Dental P A 10450 185th St W Ste 500 Lakeville MN 55044-6690 Ph: (952) 435-9888 |
| NPI Number | 1780235747 |
|---|---|
| Provider Enumeration Date | 09/21/2019 |
| Last Update Date | 09/21/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780235747 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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