Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ham Lake Dental PA

Organization General Practice Dentistry · NPI 1205915881

Ham Lake Dental PA is a General Practice Dentistry in Ham Lake, Minnesota. Licensed in Minnesota. Registered with an NPI since 2006.

Licensed in
MN
In the registry since
2006
Specialties on file
4
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

17565 Central Ave NE
Ham Lake, MN 55304
Phone: (763) 434-4188
Fax: (763) 413-7261
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X · Licence D9362 (MN)
General Practice Dentistry Taxonomy 1223G0001X · Licence D10416 (MN)
General Practice Dentistry Taxonomy 1223G0001X · Licence D10544 (MN)
General Practice Dentistry Taxonomy 1223G0001X · Licence D9466 (MN)

Record details

NPI number1205915881
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Michele Revoir — Dentist · (763) 434-4188
NPI enumeratedNovember 3, 2006
Last updated in NPPESAugust 22, 2020
Mailing address17565 Central Ave Ne, Ham Lake, MN 55304

Other providers in Ham Lake