Provider Demographics
NPI:1881849636
Name:LAKE MARION DENTAL CARE
Entity Type:Organization
Organization Name:LAKE MARION DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOMELAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-985-8885
Mailing Address - Street 1:19950 DODD BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-6341
Mailing Address - Country:US
Mailing Address - Phone:952-985-8885
Mailing Address - Fax:952-985-8099
Practice Address - Street 1:19950 DODD BLVD
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-6341
Practice Address - Country:US
Practice Address - Phone:952-985-8885
Practice Address - Fax:952-985-8099
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOMELAND DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty