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16138 Pilot Knob Rd Lakeville MN 55044 | |
(952) 679-7779 | |
(952) 679-7778 |
Full Name | |
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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 |
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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 |
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Provider Enumeration Date | 03/28/2018 |
Last Update Date | 06/05/2018 |
Identifier | Type | State | Issuer |
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1043715204 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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122300000X | Dentist | (* (Not Available)) | Primary |
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