| NPI | 1376409276 |
|---|---|
| Doing Business As | SOUTHSIDE EAST LAKE STREET DENTAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | ANN CAZABAN Executive Director 612-827-7181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2026-01-05 |
| Last Update Date | 2026-01-12 |