G2 Dental
Dentist in Forest Lake, MN. Organization (NPI-2).
NPI number1790776144
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1790776144
- Entity type
- Organization (NPI-2)
- Legal business name
- G2 Dental
- Organization subpart
- No
- Enumeration date
- Nov 3, 2005
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 8009 | MN | Yes |
| 122300000X | Dentist | 8109 | MN | |
| 122300000X | Dentist | 9975 | MN | |
| 122300000X | Dentist | 11691 | MN |
Practice location
1068 Lake St S#209
Forest Lake, MN 55025-2639
Phone 651-464-2248 · Fax 651-464-7944
Mailing address
1068 Lake St S#209
Forest Lake, MN 55025-2639
Phone 651-464-2248 · Fax 651-464-7944
Authorized official
Tracey M Koch
Office Manager
6514642248
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