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12 North Broadway Gilbert MN 55741 | |
(218) 741-5357 | |
(218) 741-5455 |
Full Name | |
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Speciality | Dentist - General Practice |
Location | 12 North Broadway, Gilbert, Minnesota |
Authorized Official Name and Position | Mark A. Erickson (PRESIDENT) |
Authorized Official Contact | 2187415357 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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P.o. Box 608 Virginia/gilbert Family Dental Gilbert MN 55741 Ph: (218) 741-5357 | 12 North Broadway Gilbert MN 55741 Ph: (218) 741-5357 |
NPI Number | 1790012847 |
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Provider Enumeration Date | 11/11/2009 |
Last Update Date | 11/11/2009 |
Identifier | Type | State | Issuer |
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1790012847 | NPI | - | NPPES |
10580600700 | Other | STATE OF MINNESOTA |
Taxonomy | Type | License (State) | Status |
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1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |