| West Lakes Dentistry, Pa | |
|
5205 Shoreline Dr Mound MN 55364-1770 | |
| (952) 472-7717 | |
| Not Available |
| Full Name | West Lakes Dentistry, Pa |
|---|---|
| Speciality | Dentist |
| Location | 5205 Shoreline Dr, Mound, Minnesota |
| Authorized Official Name and Position | Stephanie Miner (OWNER) |
| Authorized Official Contact | 9524727717 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| West Lakes Dentistry, Pa 5205 Shoreline Dr Mound MN 55364-1770 Ph: () - | West Lakes Dentistry, Pa 5205 Shoreline Dr Mound MN 55364-1770 Ph: (952) 472-7717 |
| NPI Number | 1497113674 |
|---|---|
| Provider Enumeration Date | 02/03/2016 |
| Last Update Date | 02/03/2016 |
| Medicare PECOS PAC ID | 6709182975 |
|---|---|
| Medicare Enrollment ID | O20160315000452 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497113674 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | D11974 (Minnesota) | Primary |
| Provider Name | Stephanie Miner |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1750470068 PECOS PAC ID: 7517263783 Enrollment ID: I20160315000528 |
Advanced Dental Care Services Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2363 Commerce Blvd, Mound, MN 55364 Phone: 952-472-1182 |