Lake Street Family Dental PA

NPI #1083096085 in Mora, Minnesota

Provider Information

NPI Number: 1083096085
Entity Type: Organization
Organization Name: Lake Street Family Dental PA
Primary Specialty: Dentist
Enumeration Date: Jun 25, 2015
Last Updated: Jun 25, 2015

Practice Location

Address: 119 LAKE ST S
Address 2: SUITE 1
City: Mora
State: Minnesota
ZIP Code: 55051-1576
Phone: (320) 679-2435

Authorized Official

Name: DR. STEVEN NELSON HOLCOMBE, DMD
Title: PRESIDENT
Phone: (763) 350-6234

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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