| Big Lake Dental, Pa | |
|
16991 198th Avenue Nw Big Lake MN 55309-0249 | |
| (763) 263-6350 | |
| (763) 263-0136 |
| Full Name | Big Lake Dental, Pa |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 16991 198th Avenue Nw, Big Lake, Minnesota |
| Authorized Official Name and Position | Roger J Bromaghim (OWNER) |
| Authorized Official Contact | 7632636350 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Big Lake Dental, Pa Po Box 249 Big Lake MN 55309-0249 Ph: (763) 263-6350 | Big Lake Dental, Pa 16991 198th Avenue Nw Big Lake MN 55309-0249 Ph: (763) 263-6350 |
| NPI Number | 1518141548 |
|---|---|
| Provider Enumeration Date | 12/27/2007 |
| Last Update Date | 12/27/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518141548 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D9355 (Minnesota) | Primary |
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