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General NPI Number Information
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NPI Number | 1003093485
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Entity Type | Organization
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Legal Business Name | LAKEVILLE ORTHODONTIC ASSOCIATES LLC
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Dates
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Enumeration Date | 01/28/2008
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Last Update Date | 01/28/2008
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Provider Practice Location Address
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Address Line | 10440 185TH ST W SUITE 300
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City | LAKEVILLE
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State | MN
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Zip | 55044-6678
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Country | US
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Telephone | 952-435-4000
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Fax | 952-435-8001
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Provider Business Mailing Address
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Address Line | 10440 185TH ST W SUITE 300
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City | LAKEVILLE
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State | MN
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Zip | 55044-6678
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Country | US
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Telephone | 952-435-4000
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Fax | 952-435-8001
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. SCOTT R BOWLBY
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Credential | D.D.S.
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Telephone | 952-435-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D12240
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License Number State | MN
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