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Contact Information

GREAT LAKES CHILDRENS DENTAL CARE PA
2710 PIEDMONT AVENUE
DULUTH, MN55811
 Phone: 218-525-5100
 Fax: 218-722-3883
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dental Public Health

1223D0001X
 

Pediatric Dentistry

1223P0221X
Indicates primary specialty

NPI Profile & details for GREAT LAKES CHILDRENS DENTAL CARE PA · (Female)

NPI Number 1790795821
Status Active
Credentials
Entity Individual
Enumeration date 08/09/2006
Last updated 09/11/2025 - About 9 months ago
Sole proprietor 1 Not specified
Identifiers
  • MN License # D10919
  • MN License # D11559
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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