| Center Lake Dental, Pa | |
|
420 Grand Ave Center City MN 55012-3553 | |
| (651) 257-1140 | |
| Not Available |
| Full Name | Center Lake Dental, Pa |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 420 Grand Ave, Center City, Minnesota |
| Authorized Official Name and Position | Geoffrey D Archibald (OWNER) |
| Authorized Official Contact | 6516747096 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Center Lake Dental, Pa 420 Grand Ave Center City MN 55012-3553 Ph: (651) 257-1140 | Center Lake Dental, Pa 420 Grand Ave Center City MN 55012-3553 Ph: (651) 257-1140 |
| NPI Number | 1871954651 |
|---|---|
| Provider Enumeration Date | 03/08/2016 |
| Last Update Date | 03/08/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871954651 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |