| Green Lake Dental | |
|
163 Highway 23 Ne Ste 1 Spicer MN 56288-9735 | |
| (320) 796-2158 | |
| (320) 409-1180 |
| Full Name | Green Lake Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 163 Highway 23 Ne Ste 1, Spicer, Minnesota |
| Authorized Official Name and Position | Kirby Melvin Johnson (PRESIDENT) |
| Authorized Official Contact | 3207962158 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Green Lake Dental 163 Highway 23 Ne Ste 1 Spicer MN 56288-9735 Ph: (320) 796-2158 | Green Lake Dental 163 Highway 23 Ne Ste 1 Spicer MN 56288-9735 Ph: (320) 796-2158 |
| NPI Number | 1841686359 |
|---|---|
| Provider Enumeration Date | 04/10/2015 |
| Last Update Date | 02/02/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841686359 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |