| NPI | 1922619162 |
|---|---|
| Doing Business As | BIRCH LAKE DENTAL |
| Entity Type | Organization |
| Authorized Contact | GEETHA J DAMODARAN Owner 651-429-0404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2020-08-12 |
| Last Update Date | 2020-08-12 |