| West River Dental Care | |
|
4103 E Lake St Minneapolis MN 55406-2259 | |
| (612) 721-2424 | |
| (612) 721-3054 |
| Full Name | West River Dental Care |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4103 E Lake St, Minneapolis, Minnesota |
| Authorized Official Name and Position | Michael Paul Skadron (OWNER) |
| Authorized Official Contact | 6127212424 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| West River Dental Care 4103 E Lake St Minneapolis MN 55406-2259 Ph: (612) 721-2424 | West River Dental Care 4103 E Lake St Minneapolis MN 55406-2259 Ph: (612) 721-2424 |
| NPI Number | 1033223581 |
|---|---|
| Provider Enumeration Date | 08/19/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033223581 | NPI | - | NPPES |
| 7B839SK | Other | MN | BCBS PROVIDER # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 10636 (Minnesota) | Primary |
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