| NPI | 1831703347 |
|---|---|
| Doing Business As | CRYSTAL LAKE DENTAL CARE |
| Entity Type | Organization |
| Authorized Contact | SAM JACOBSON Business Manager 763-588-8426 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2020-09-02 |
| Last Update Date | 2020-09-02 |