| |
701 Highway 10 E Detroit Lakes MN 56501-4219 | |
(218) 847-9214 | |
(218) 847-9215 |
Full Name | |
---|---|
Speciality | Dentist - General Practice |
Location | 701 Highway 10 E, Detroit Lakes, Minnesota |
Authorized Official Name and Position | Kristine M Riewer (OWNER) |
Authorized Official Contact | 2188479214 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 517 Detroit Lakes MN 56502-0517 Ph: (218) 847-9214 | 701 Highway 10 E Detroit Lakes MN 56501-4219 Ph: (218) 847-9214 |
NPI Number | 1316022387 |
---|---|
Provider Enumeration Date | 10/26/2006 |
Last Update Date | 08/26/2010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1316022387 | NPI | - | NPPES |
372149300 | Medicaid | MN | |
719517600 | Medicaid | MN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |