| NPI | 1366096513 |
|---|---|
| Doing Business As | PARK DENTAL PLYMOUTH LAKES |
| Entity Type | Organization |
| Authorized Contact | SHANNON HESSE Credentialing Specialist 651-746-2815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-07-26 |
| Last Update Date | 2020-10-28 |