| NPI | 1679142673 |
|---|---|
| Doing Business As | GLEN LAKE FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | ALEX SCOTT Owner 952-938-6038 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2022-10-26 |