Lake Valley Dental Pllc | |
1511 Broadway Wheaton MN 56296-1040 | |
(320) 563-4800 | |
Not Available |
Full Name | Lake Valley Dental Pllc |
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Speciality | Clinic/center - Dental |
Location | 1511 Broadway, Wheaton, Minnesota |
Authorized Official Name and Position | Johnathan Wermers (DENTIST) |
Authorized Official Contact | 6057708667 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Lake Valley Dental Pllc 1511 Broadway Wheaton MN 56296-1040 Ph: (320) 563-4800 | Lake Valley Dental Pllc 1511 Broadway Wheaton MN 56296-1040 Ph: (320) 563-4800 |
NPI Number | 1720755531 |
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Provider Enumeration Date | 08/28/2021 |
Last Update Date | 08/28/2021 |
Identifier | Type | State | Issuer |
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1720755531 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |