| Moore Lake Dental | |
|
6230 Highway 65 Ne Suite 105 Fridley MN 55432-5107 | |
| (763) 571-5497 | |
| Not Available |
| Full Name | Moore Lake Dental |
|---|---|
| Speciality | Dentist |
| Location | 6230 Highway 65 Ne, Fridley, Minnesota |
| Authorized Official Name and Position | Lisa Murray Perez (OWNER) |
| Authorized Official Contact | 6124142182 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Moore Lake Dental 6230 Highway 65 Ne Suite 105 Fridley MN 55432-5107 Ph: (763) 571-5497 | Moore Lake Dental 6230 Highway 65 Ne Suite 105 Fridley MN 55432-5107 Ph: (763) 571-5497 |
| NPI Number | 1386035590 |
|---|---|
| Provider Enumeration Date | 02/10/2015 |
| Last Update Date | 02/10/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386035590 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D10520 (Minnesota) | Primary |
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