| Lift Dental Pllc | |
|
124 2nd St S Ste 101 Stillwater MN 55082-5179 | |
| (651) 439-4945 | |
| Not Available |
| Full Name | Lift Dental Pllc |
|---|---|
| Speciality | Dentist |
| Location | 124 2nd St S Ste 101, Stillwater, Minnesota |
| Authorized Official Name and Position | Sara Elizabeth Leonette Cody (DENTIST) |
| Authorized Official Contact | 6514394945 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lift Dental Pllc 225 2nd St N Stillwater MN 55082-5058 Ph: (651) 439-4945 | Lift Dental Pllc 124 2nd St S Ste 101 Stillwater MN 55082-5179 Ph: (651) 439-4945 |
| NPI Number | 1083178149 |
|---|---|
| Provider Enumeration Date | 01/23/2019 |
| Last Update Date | 03/01/2019 |
| Medicare PECOS PAC ID | 7214270651 |
|---|---|
| Medicare Enrollment ID | O20190528001673 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083178149 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223D0001X | Dentist - Dental Public Health | (* (Not Available)) | Primary |
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