| Forest Lake Endodontics | |
|
1420 Lake St S Ste 200 Forest Lake MN 55025-2713 | |
| (651) 464-9888 | |
| Not Available |
| Full Name | Forest Lake Endodontics |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 1420 Lake St S Ste 200, Forest Lake, Minnesota |
| Authorized Official Name and Position | Renee Irene Klossner (OFFICE MANAGER) |
| Authorized Official Contact | 6514649888 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Forest Lake Endodontics 1420 Lake St S Ste 200 Forest Lake MN 55025-2713 Ph: (651) 464-9888 | Forest Lake Endodontics 1420 Lake St S Ste 200 Forest Lake MN 55025-2713 Ph: (651) 464-9888 |
| NPI Number | 1871106393 |
|---|---|
| Provider Enumeration Date | 08/25/2020 |
| Last Update Date | 09/08/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871106393 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | (* (Not Available)) | Primary |
Travis W. Wille, Dds, Ms Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 25 Lake St N, Suite 135, Forest Lake, MN 55025 Phone: 651-464-1151 Fax: 651-464-0620 | |
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