| NPI | 1508318247 |
|---|---|
| Doing Business As | WILLOW LAKE DENTAL |
| Entity Type | Organization |
| Authorized Contact | MARK ST DENNIS General Manager 651-341-2106 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2016-10-28 |
| Last Update Date | 2016-10-28 |