| Madison Lake Family Dental Care | |
|
516 Main St Madison Lake MN 56063-2027 | |
| (507) 243-3747 | |
| Not Available |
| Full Name | Madison Lake Family Dental Care |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 516 Main St, Madison Lake, Minnesota |
| Authorized Official Name and Position | Brandon J Kelly (OWNER) |
| Authorized Official Contact | 5073820642 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Madison Lake Family Dental Care 516 Main St Madison Lake MN 56063-2027 Ph: (507) 243-3747 | Madison Lake Family Dental Care 516 Main St Madison Lake MN 56063-2027 Ph: (507) 243-3747 |
| NPI Number | 1235528233 |
|---|---|
| Provider Enumeration Date | 01/13/2015 |
| Last Update Date | 01/13/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235528233 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D12709 (Minnesota) | Primary |
Bryan D. Johnson, Dds, Pa Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 516 Main Street, Madison Lake, MN 56063 Phone: 507-243-3747 Fax: 507-243-3866 |