| NPI | 1215174917 |
|---|---|
| Doing Business As | ANDERSON LAKE DENTAL |
| Entity Type | Organization |
| Authorized Contact | SHIRAZ MOHAMMAD ASIF Owner/Dentist 952-942-0823 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: MN D12191) |
| Enumeration Date | 2009-01-16 |
| Last Update Date | 2009-01-16 |