LAKES DENTAL CARE PLC
NPI: 1578682050
· PEQUOT LAKES, MN 56472
· General Practice Dentistry
· NPI assigned 03/28/2007
$429.96
Total Medicaid Paid
Provider Details
| Authorized Official | OLSON, JEFFREY (OWNER) |
| NPI Enumeration Date | 03/28/2007 |
Related Entities
Other providers sharing the same authorized official: OLSON, JEFFREY
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
37 |
$0.00 |
| 2021 |
24 |
$429.96 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
37 |
37 |
$232.80 |
| D1206 |
Topical application of fluoride varnish |
24 |
24 |
$197.16 |