| NPI | 1104435585 |
|---|---|
| Doing Business As | FOUNTAIN LAKE FAMILY DENTAL |
| Entity Type | Organization |
| Authorized Contact | KARISA LEHMANN Office Manager 507-373-3323 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2020-07-30 |
| Last Update Date | 2020-07-30 |