Lake Minnetonka Dental Center Pllc

NPI #1215590575 in Wayzata, Minnesota

Provider Information

NPI Number: 1215590575
Entity Type: Organization
Organization Name: Lake Minnetonka Dental Center Pllc
Primary Specialty: Dentist
Enumeration Date: Apr 22, 2019
Last Updated: Apr 22, 2019

Practice Location

Address: 109 BUSHAWAY RD STE 300
City: Wayzata
State: Minnesota
ZIP Code: 55391-2079
Phone: (952) 475-0225

Authorized Official

Name: MIKE COLE
Title: VP INSURANCE PLAN MANAGEMENT
Phone: (941) 955-3150

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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