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11183 205th St W Lakeville MN 55044-9827 | |
| (952) 469-4588 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 11183 205th St W, Lakeville, Minnesota |
| Authorized Official Name and Position | Mackenzie King Platt (OWNER) |
| Authorized Official Contact | 9524694588 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
11183 205th St W Lakeville MN 55044-9827 Ph: (952) 469-4588 | 11183 205th St W Lakeville MN 55044-9827 Ph: (952) 469-4588 |
| NPI Number | 1467268441 |
|---|---|
| Provider Enumeration Date | 12/05/2024 |
| Last Update Date | 01/09/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467268441 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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