| Lakeside Family Dentistry | |
|
1880 W Wayzata Blvd Long Lake MN 55356-9491 | |
| (952) 475-0989 | |
| (952) 475-2053 |
| Full Name | Lakeside Family Dentistry |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1880 W Wayzata Blvd, Long Lake, Minnesota |
| Authorized Official Name and Position | Michael E. Giebenhain (OWNER) |
| Authorized Official Contact | 9524750989 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Family Dentistry 1880 W Wayzata Blvd P.o.box 128 Long Lake MN 55356-9491 Ph: (952) 475-0989 | Lakeside Family Dentistry 1880 W Wayzata Blvd Long Lake MN 55356-9491 Ph: (952) 475-0989 |
| NPI Number | 1790146587 |
|---|---|
| Provider Enumeration Date | 03/08/2016 |
| Last Update Date | 03/08/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790146587 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
Long Lake Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1870 W Wayzata Blvd, Long Lake, MN 55356 Phone: 952-473-7151 Fax: 952-475-1539 |