| Elko-new Market Dental Clinic | |
|
9202 202nd St W Suite 201 Lakeville MN 55044-7915 | |
| (952) 469-2818 | |
| (952) 469-2566 |
| Full Name | Elko-new Market Dental Clinic |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 9202 202nd St W, Lakeville, Minnesota |
| Authorized Official Name and Position | Steven Blaine Petersen (OWNER) |
| Authorized Official Contact | 9524692818 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Elko-new Market Dental Clinic 9202 202nd St W Suite 201 Lakeville MN 55044-7915 Ph: (952) 469-2818 | Elko-new Market Dental Clinic 9202 202nd St W Suite 201 Lakeville MN 55044-7915 Ph: (952) 469-2818 |
| NPI Number | 1720199953 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720199953 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D10525 (Minnesota) | Primary |
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