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1106 W River Rd Detroit Lakes MN 56501-2723 | |
(218) 846-1900 | |
(218) 847-5079 |
Full Name | |
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Speciality | Dentist - General Practice |
Location | 1106 W River Rd, Detroit Lakes, Minnesota |
Authorized Official Name and Position | John R Jordan (OWNER) |
Authorized Official Contact | 2188461900 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1106 W River Rd Detroit Lakes MN 56501-2723 Ph: (218) 846-1900 | 1106 W River Rd Detroit Lakes MN 56501-2723 Ph: (218) 846-1900 |
NPI Number | 1609008051 |
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Provider Enumeration Date | 08/19/2009 |
Last Update Date | 08/19/2009 |
Identifier | Type | State | Issuer |
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1609008051 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1223G0001X | Dentist - General Practice | D10689 (Minnesota) | Primary |
1223G0001X | Dentist - General Practice | D12441 (Minnesota) | Secondary |