Healthcare Provider Details

I. General information

NPI: 1598521304
Provider Name (Legal Business Name): SPRING LAKE PARK DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8414 FILLMORE ST NE
SPRING LAKE PARK MN
55432-1266
US

IV. Provider business mailing address

N8811 1225TH ST
RIVER FALLS WI
54022-4779
US

V. Phone/Fax

Practice location:
  • Phone: 763-792-6672
  • Fax:
Mailing address:
  • Phone: 651-334-6957
  • 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: MICHAEL A MCFARLAND
Title or Position: PRESIDENT
Credential: DDS
Phone: 651-334-6957