NPI 1104255371

Great Lakes Endodontics

Organisation Dental Clinic/Center Hermantown, MN

Practice location

Address: 4815 W Arrowhead Rd, Hermantown, MN 55811-4004
Phone: (218) 772-0772

Authorised official

Name: Mark Terrance Phillips
Title: Dentist
Phone: (651) 528-0240

Registered specialties

Dental Clinic/Center Primary

Ambulatory Health Care Facilities Taxonomy 261QD0000X Licence D12534 (MN)

Other Clinic/Center providers in Minnesota →

Registry record

NPI: 1104255371
Entity type: Organization
NPI issued: 7 Nov 2013
Record last updated: 7 Nov 2013

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.