| Lake Nokomis Dental | |
|
4927 34th Ave S Minneapolis MN 55417-1552 | |
| (612) 729-6150 | |
| (612) 722-8817 |
| Full Name | Lake Nokomis Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4927 34th Ave S, Minneapolis, Minnesota |
| Authorized Official Name and Position | Dan M Proeschel (OWNER) |
| Authorized Official Contact | 6127296150 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Nokomis Dental 4927 34th Ave S Minneapolis MN 55417-1552 Ph: (612) 729-6150 | Lake Nokomis Dental 4927 34th Ave S Minneapolis MN 55417-1552 Ph: (612) 729-6150 |
| NPI Number | 1568648871 |
|---|---|
| Provider Enumeration Date | 01/16/2008 |
| Last Update Date | 01/16/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568648871 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D7926 (Minnesota) | Primary |
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