| Lake County Dental Ltd | |
|
402 James St Brainerd MN 56401-2965 | |
| (218) 829-4243 | |
| (218) 825-8102 |
| Full Name | Lake County Dental Ltd |
|---|---|
| Speciality | Dentist |
| Location | 402 James St, Brainerd, Minnesota |
| Authorized Official Name and Position | Jeffrey John Mattson (OWNER) |
| Authorized Official Contact | 2188294243 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake County Dental Ltd 402 James St Brainerd MN 56401-2965 Ph: (218) 829-4243 | Lake County Dental Ltd 402 James St Brainerd MN 56401-2965 Ph: (218) 829-4243 |
| NPI Number | 1558361667 |
|---|---|
| Provider Enumeration Date | 07/29/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558361667 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | MATTSON 10813 (Minnesota) | Secondary |
| 122300000X | Dentist | MOEN 9531 (Minnesota) | Primary |
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