| Grand Dental Center | |
|
1604 Golf Course Rd Grand Rapids MN 55744-8648 | |
| (218) 326-0339 | |
| (218) 999-5443 |
| Full Name | Grand Dental Center |
|---|---|
| Speciality | Dentist |
| Location | 1604 Golf Course Rd, Grand Rapids, Minnesota |
| Authorized Official Name and Position | Lisa M Johnson (DENTIST) |
| Authorized Official Contact | 2183260339 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Dental Center 1604 Golf Course Rd Grand Rapids MN 55744-8648 Ph: (218) 326-0339 | Grand Dental Center 1604 Golf Course Rd Grand Rapids MN 55744-8648 Ph: (218) 326-0339 |
| NPI Number | 1457644049 |
|---|---|
| Provider Enumeration Date | 05/16/2011 |
| Last Update Date | 05/16/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457644049 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D11285 (Minnesota) | Primary |
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