| 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 |