| Park Dental Plymouth Lakes | |
|
1525 County Road 101 N Plymouth MN 55447-2707 | |
| (763) 475-2829 | |
| Not Available |
| Full Name | Park Dental Plymouth Lakes |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1525 County Road 101 N, Plymouth, Minnesota |
| Authorized Official Name and Position | Shannon Hesse (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 6517462815 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Park Dental Plymouth Lakes 2200 County Road C W Ste 2210 Roseville MN 55113-2551 Ph: (651) 746-2815 | Park Dental Plymouth Lakes 1525 County Road 101 N Plymouth MN 55447-2707 Ph: (763) 475-2829 |
| NPI Number | 1366096513 |
|---|---|
| Provider Enumeration Date | 07/26/2019 |
| Last Update Date | 10/28/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366096513 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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