Moore Lake Dental

NPI #1386035590 in Fridley, Minnesota

Provider Information

NPI Number: 1386035590
Entity Type: Organization
Organization Name: Moore Lake Dental
Primary Specialty: Dentist
Enumeration Date: Feb 10, 2015
Last Updated: Feb 10, 2015

Practice Location

Address: 6230 HIGHWAY 65 NE
Address 2: SUITE 105
City: Fridley
State: Minnesota
ZIP Code: 55432-5107
Phone: (763) 571-5497

Authorized Official

Name: DR. LISA MURRAY PEREZ, D.D.S.
Title: OWNER
Phone: (612) 414-2182

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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