| Park Dental | |
|
11240 Stillwater Blvd N Lake Elmo MN 55042-9321 | |
| (651) 777-0210 | |
| (651) 777-0320 |
| Full Name | Park Dental |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 11240 Stillwater Blvd N, Lake Elmo, Minnesota |
| Authorized Official Name and Position | John Gulon (PRESIDENT) |
| Authorized Official Contact | 6516330500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Park Dental 2200 County Road C W Suite 2210 Roseville MN 55113-2550 Ph: (651) 633-0500 | Park Dental 11240 Stillwater Blvd N Lake Elmo MN 55042-9321 Ph: (651) 777-0210 |
| NPI Number | 1639509334 |
|---|---|
| Provider Enumeration Date | 11/15/2013 |
| Last Update Date | 10/28/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639509334 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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City Walk Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 10035 City Walk Dr, Ste A Lake Elmo Dental, Lake Elmo, MN 55042 Phone: 651-714-5555 Fax: 651-439-2211 | |
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