Healthcare Provider Details

I. General information

NPI: 1346187630
Provider Name (Legal Business Name): BATTLE LAKE FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 S LAKE AVE
BATTLE LAKE MN
56515-4238
US

IV. Provider business mailing address

412 S LAKE AVE
BATTLE LAKE MN
56515-4238
US

V. Phone/Fax

Practice location:
  • Phone: 218-864-5245
  • Fax:
Mailing address:
  • Phone: 218-864-5245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAMMY L ANDERSON
Title or Position: OWNER
Credential: DDS
Phone: 218-346-7186