| Valley Ridge Dental, Llc | |
|
12425 55th St N Lake Elmo MN 55042-7403 | |
| (651) 439-0322 | |
| Not Available |
| Full Name | Valley Ridge Dental, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 12425 55th St N, Lake Elmo, Minnesota |
| Authorized Official Name and Position | Chad Loween (CO-OWNER) |
| Authorized Official Contact | 6517665771 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Valley Ridge Dental, Llc 4666 Dale St N Shoreview MN 55126-6021 Ph: (651) 766-5771 | Valley Ridge Dental, Llc 12425 55th St N Lake Elmo MN 55042-7403 Ph: (651) 439-0322 |
| NPI Number | 1265644926 |
|---|---|
| Provider Enumeration Date | 05/04/2007 |
| Last Update Date | 06/23/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265644926 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D11362 (Minnesota) | Primary |
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