| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | Po Box 497, Redlake, Minnesota |
| Authorized Official Name and Position | Janice Marie Thunder (BUSINESS OFFICE MANAGER) |
| Authorized Official Contact | 2186793912 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
24760 Hospital Drive Box 497 C/o Business Office Red Lake MN 56671 Ph: (218) 679-3912 | Po Box 497 Redlake MN 56671-0497 Ph: (218) 679-3912 |
| NPI Number | 1609392992 |
|---|---|
| Provider Enumeration Date | 08/17/2017 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609392992 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (Minnesota) | Primary |