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1516 W Lake St Suite 302 Minneapolis MN 55408-2554 | |
| (612) 822-4184 | |
| (612) 822-9458 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1516 W Lake St, Minneapolis, Minnesota |
| Authorized Official Name and Position | Patrick James Prochaska (PRESIDENT) |
| Authorized Official Contact | 6128221484 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1516 W Lake St Suite 302 Minneapolis MN 55408-2554 Ph: (612) 822-4184 | 1516 W Lake St Suite 302 Minneapolis MN 55408-2554 Ph: (612) 822-4184 |
| NPI Number | 1932206539 |
|---|---|
| Provider Enumeration Date | 09/19/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932206539 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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