Ham Lake Dental PA

NPI #1205915881 in Ham Lake, Minnesota

Provider Information

NPI Number: 1205915881
Entity Type: Organization
Organization Name: Ham Lake Dental PA
Primary Specialty: Dentist - General Practice
Enumeration Date: Nov 3, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: 17565 CENTRAL AVE NE
City: Ham Lake
State: Minnesota
ZIP Code: 55304
Phone: (763) 434-4188

Authorized Official

Name: MICHELE MARIE REVOIR, DDS
Title: DENTIST
Phone: (763) 434-4188

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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