| Red River Dental Clinic Ltd | |
|
1416 Central Ave Ne East Grand Forks MN 56721-1605 | |
| (218) 773-3004 | |
| (218) 773-3006 |
| Full Name | Red River Dental Clinic Ltd |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1416 Central Ave Ne, East Grand Forks, Minnesota |
| Authorized Official Name and Position | Craig Alan Johnson (OWNER) |
| Authorized Official Contact | 2187733004 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Red River Dental Clinic Ltd 1416 Central Ave Ne East Grand Forks MN 56721-1605 Ph: (218) 773-3004 | Red River Dental Clinic Ltd 1416 Central Ave Ne East Grand Forks MN 56721-1605 Ph: (218) 773-3004 |
| NPI Number | 1780085928 |
|---|---|
| Provider Enumeration Date | 09/08/2014 |
| Last Update Date | 09/08/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780085928 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D13228 (Minnesota) | Primary |
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