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1870 W Wayzata Blvd Long Lake MN 55356-9491 | |
(952) 473-7151 | |
(952) 475-1539 |
Full Name | |
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Speciality | Dentist |
Location | 1870 W Wayzata Blvd, Long Lake, Minnesota |
Authorized Official Name and Position | Douglas J. Mcnaught (DOCTOR/OWNER) |
Authorized Official Contact | 9524737151 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 695 Long Lake MN 55356-0695 Ph: (952) 473-7151 | 1870 W Wayzata Blvd Long Lake MN 55356-9491 Ph: (952) 473-7151 |
NPI Number | 1053585653 |
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Provider Enumeration Date | 04/15/2008 |
Last Update Date | 07/01/2008 |
Identifier | Type | State | Issuer |
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1053585653 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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122300000X | Dentist | D9985 (Minnesota) | Primary |