| Rice Lake Dental, P.a. | |
|
13998 Maple Knoll Way Ste 100 Maple Grove MN 55369-7004 | |
| (763) 420-5599 | |
| (763) 416-4771 |
| Full Name | Rice Lake Dental, P.a. |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 13998 Maple Knoll Way Ste 100, Maple Grove, Minnesota |
| Authorized Official Name and Position | Darrel Howard Johnsrud (PRESIDENT) |
| Authorized Official Contact | 6123856718 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rice Lake Dental, P.a. 13998 Maple Knoll Way Ste 100 Maple Grove MN 55369-7004 Ph: (763) 420-5599 | Rice Lake Dental, P.a. 13998 Maple Knoll Way Ste 100 Maple Grove MN 55369-7004 Ph: (763) 420-5599 |
| NPI Number | 1760107502 |
|---|---|
| Provider Enumeration Date | 10/04/2022 |
| Last Update Date | 10/04/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760107502 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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