| Lake Valley Dental Pllc | |
|
1511 Broadway Wheaton MN 56296-1040 | |
| (320) 563-4800 | |
| Not Available |
| Full Name | Lake Valley Dental Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1511 Broadway, Wheaton, Minnesota |
| Authorized Official Name and Position | Johnathan Wermers (DENTIST) |
| Authorized Official Contact | 6057708667 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Valley Dental Pllc 1511 Broadway Wheaton MN 56296-1040 Ph: (320) 563-4800 | Lake Valley Dental Pllc 1511 Broadway Wheaton MN 56296-1040 Ph: (320) 563-4800 |
| NPI Number | 1720755531 |
|---|---|
| Provider Enumeration Date | 08/28/2021 |
| Last Update Date | 08/28/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720755531 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |