Chicago Lake Dental
NPI #1497936389 in Minneapolis, Minnesota
Provider Information
- NPI Number
- 1497936389
- Entity Type
- Organization
- Organization Name
- Chicago Lake Dental
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Nov 19, 2007
- Last Updated
- Nov 19, 2007
Practice Location
- Address
- 2900 CHICAGO AVE
- City
- Minneapolis
- State
- Minnesota
- ZIP Code
- 55407-1322
- Phone
- (612) 823-2080
Authorized Official
- Name
- DR. DAVID WILLIAM JOHNSON JR., DDS
- Title
- OWNER
- Phone
- (612) 823-2080
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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