NPI 1386035590

Moore Lake Dental

Organisation Dentist Fridley, MN

Practice location

Address: 6230 Highway 65 NE Suite 105, Fridley, MN 55432-5107
Phone: (763) 571-5497

Authorised official

Name: Lisa Murray Perez
Title: Owner
Phone: (612) 414-2182

Registered specialties

Dentist Primary

Dental Providers Taxonomy 122300000X Licence D10520 (MN)

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Registry record

NPI: 1386035590
Entity type: Organization
NPI issued: 10 Feb 2015
Record last updated: 10 Feb 2015

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.