| Glen Lake Dental Associates, P.a. | |
|
14418 Excelsior Blvd Minnetonka MN 55345-5820 | |
| (952) 935-5212 | |
| (952) 935-1391 |
| Full Name | Glen Lake Dental Associates, P.a. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 14418 Excelsior Blvd, Minnetonka, Minnesota |
| Authorized Official Name and Position | Kent Cassidy (PRESIDENT) |
| Authorized Official Contact | 9529355212 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Glen Lake Dental Associates, P.a. 14418 Excelsior Blvd Minnetonka MN 55345-5820 Ph: (952) 935-5212 | Glen Lake Dental Associates, P.a. 14418 Excelsior Blvd Minnetonka MN 55345-5820 Ph: (952) 935-5212 |
| NPI Number | 1003062084 |
|---|---|
| Provider Enumeration Date | 08/11/2008 |
| Last Update Date | 08/11/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003062084 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D9306 (Minnesota) | Primary |
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