| NPI | 1508594664 |
|---|---|
| Doing Business As | CLEAR LAKES DENTAL |
| Entity Type | Organization |
| Authorized Contact | DAVID J PARK CEO/President/Owner 651-444-9644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2022-08-08 |
| Last Update Date | 2022-08-08 |