Provider Demographics
NPI:1093828261
Name:LOWRY HILL DENTAL CLINIC PATRICK J PROCHASKA DDS ET.AL PARTNERS
Entity Type:Organization
Organization Name:LOWRY HILL DENTAL CLINIC PATRICK J PROCHASKA DDS ET.AL PARTNERS
Other - Org Name:LOWRY HILL DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATICK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PROCHASKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:612-823-7942
Mailing Address - Street 1:1516 W LAKE ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2554
Mailing Address - Country:US
Mailing Address - Phone:612-822-1484
Mailing Address - Fax:612-822-9458
Practice Address - Street 1:1516 W LAKE ST
Practice Address - Street 2:SUITE 302
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2554
Practice Address - Country:US
Practice Address - Phone:612-822-1484
Practice Address - Fax:612-822-9458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND90451223G0001X
MND91381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty