| NPI | 1770283475 |
|---|---|
| Doing Business As | CLEAR LAKES DENTAL |
| Entity Type | Organization |
| Authorized Contact | DAVID PARK CEO / Owner 651-444-9644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2023-03-09 |
| Last Update Date | 2023-03-09 |