MEDICARE: LOWRY HILL DENTAL CLINIC PATRICK J PROCHASKA DDS ET.AL PARTNERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D9138	MN
2	1223G0001X	General Practice Dentistry	D9045	MN

General Provider Information

NPI Number	:	1093828261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOWRY HILL DENTAL CLINIC PATRICK J PROCHASKA DDS ET.AL PARTNERS

Provider Business Mailing Address
First Line	:	1516 W LAKE ST
Second Line	:	SUITE 302
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2554
Country	:	US
Telephone Number	:	612-822-1484
Fax Number	:	612-822-9458

Provider Business Practice Location Address
First Line	:	1516 W LAKE ST
Second Line	:	SUITE 302
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2554
Country	:	US
Telephone Number	:	612-822-1484
Fax Number	:	612-822-9458

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. PATICK JAMES PROCHASKA
Credential	:	D.D.S
Telephone Number	:	612-823-7942

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	08/22/2020

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