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16138 Pilot Knob Rd Lakeville MN 55044 | |
| (952) 679-7779 | |
| (952) 679-7778 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 16138 Pilot Knob Rd, Lakeville, Minnesota |
| Authorized Official Name and Position | Jessica Britt (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2175408426 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
16138 Pilot Knob Rd Lakeville MN 55044-4105 Ph: (952) 679-7779 | 16138 Pilot Knob Rd Lakeville MN 55044 Ph: (952) 679-7779 |
| NPI Number | 1043715204 |
|---|---|
| Provider Enumeration Date | 03/28/2018 |
| Last Update Date | 06/05/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043715204 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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