| 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 |