| East Grand Forks Dental Care | |
|
22 4th St. Ne East Grand Forks MN 56721 | |
| (218) 773-0842 | |
| Not Available |
| Full Name | East Grand Forks Dental Care |
|---|---|
| Speciality | Dentist |
| Location | 22 4th St. Ne, East Grand Forks, Minnesota |
| Authorized Official Name and Position | David M Thorfinnson (PRESIDENT) |
| Authorized Official Contact | 2187730842 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Grand Forks Dental Care 22 4th St. Ne East Grand Forks MN 56721 Ph: (218) 773-0842 | East Grand Forks Dental Care 22 4th St. Ne East Grand Forks MN 56721 Ph: (218) 773-0842 |
| NPI Number | 1891912812 |
|---|---|
| Provider Enumeration Date | 04/19/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 8628460680 |
|---|---|
| Medicare Enrollment ID | O20220125000752 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891912812 | NPI | - | NPPES |
| 989049 | Other | ND | DENTAL SERVICE CORP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 10253 (Minnesota) | Primary |
| Provider Name | David Michael Thorfinnson |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1346276219 PECOS PAC ID: 6608096938 Enrollment ID: I20220125000869 |
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