| Great Lakes Childrens Dental Care Pa | |
|
2710 Piedmont Avenue Duluth MN 55811 | |
| (218) 525-5100 | |
| (218) 722-3883 |
| Full Name | Great Lakes Childrens Dental Care Pa |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2710 Piedmont Avenue, Duluth, Minnesota |
| Authorized Official Name and Position | Rami M Guirguis (OWNER) |
| Authorized Official Contact | 2185255100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Lakes Childrens Dental Care Pa 2710 Piedmont Avenue Duluth MN 55811 Ph: (218) 525-5100 | Great Lakes Childrens Dental Care Pa 2710 Piedmont Avenue Duluth MN 55811 Ph: (218) 525-5100 |
| NPI Number | 1790795821 |
|---|---|
| Provider Enumeration Date | 08/09/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790795821 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223D0001X | Dentist - Dental Public Health | D11559 (Minnesota) | Primary |
| 1223P0221X | Dentist - Pediatric Dentistry | D10919 (Minnesota) | Primary |
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