| White Bear Lake Orthodontics | |
|
4437 Lake Ave S White Bear Lake MN 55110-3455 | |
| (763) 999-0055 | |
| Not Available |
| Full Name | White Bear Lake Orthodontics |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 4437 Lake Ave S, White Bear Lake, Minnesota |
| Authorized Official Name and Position | Tamara Smith (OWNER/ORTHODONTIST) |
| Authorized Official Contact | 7639990055 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| White Bear Lake Orthodontics 4437 Lake Ave S White Bear Lake MN 55110-3455 Ph: (763) 999-0055 | White Bear Lake Orthodontics 4437 Lake Ave S White Bear Lake MN 55110-3455 Ph: (763) 999-0055 |
| NPI Number | 1730782467 |
|---|---|
| Provider Enumeration Date | 11/17/2020 |
| Last Update Date | 11/17/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730782467 | NPI | - | NPPES |
| 1376821157 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |
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