NPI 1003062084

Glen Lake Dental Associates, P.A.

Organisation General Practice Dentistry Minnetonka, MN

Practice location

Address: 14418 Excelsior Blvd, Minnetonka, MN 55345-5820
Phone: (952) 935-5212
Fax: (952) 935-1391

Authorised official

Name: Kent Cassidy
Title: President
Phone: (952) 935-5212

Registered specialties

General Practice Dentistry Primary

Dental Providers Taxonomy 1223G0001X Licence D9306 (MN)

Other Dentist providers in Minnesota →

Registry record

NPI: 1003062084
Entity type: Organization
NPI issued: 11 Aug 2008
Record last updated: 11 Aug 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.