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General NPI Number Information
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NPI Number | 1215793401
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Entity Type | Organization
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Legal Business Name | LAKELAND DENTISTS, P.L.L.C.
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Dates
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Enumeration Date | 02/26/2024
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Last Update Date | 02/26/2024
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Provider Practice Location Address
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Address Line | 74 1ST AVE SE
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City | LITTLE FALLS
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State | MN
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Zip | 56345-3042
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Country | US
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Telephone | 320-280-0466
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Fax |
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Provider Business Mailing Address
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Address Line | 31508 291ST AVE
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City | BROWERVILLE
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State | MN
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Zip | 56438-4901
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DOMINIC GAGNON
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Credential | DDS
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Telephone | 320-280-0466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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