Provider Demographics
NPI:1598521304
Name:SPRING LAKE PARK DENTISTRY PLLC
Entity Type:Organization
Organization Name:SPRING LAKE PARK DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCFARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-334-6957
Mailing Address - Street 1:N8811 1225TH ST
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-4779
Mailing Address - Country:US
Mailing Address - Phone:651-334-6957
Mailing Address - Fax:
Practice Address - Street 1:8414 FILLMORE ST NE
Practice Address - Street 2:
Practice Address - City:SPRING LAKE PARK
Practice Address - State:MN
Practice Address - Zip Code:55432-1266
Practice Address - Country:US
Practice Address - Phone:763-792-6672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental