| Great River Dentistry Of Bemidji, P.a. | |
|
3622 Moberg Dr Nw Bemidji MN 56601-5644 | |
| (218) 751-4216 | |
| (218) 444-6057 |
| Full Name | Great River Dentistry Of Bemidji, P.a. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3622 Moberg Dr Nw, Bemidji, Minnesota |
| Authorized Official Name and Position | Douglas R Williams (OWNER) |
| Authorized Official Contact | 2187514216 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Great River Dentistry Of Bemidji, P.a. Po Box 1005 Bemidji MN 56619-1005 Ph: (218) 751-4216 | Great River Dentistry Of Bemidji, P.a. 3622 Moberg Dr Nw Bemidji MN 56601-5644 Ph: (218) 751-4216 |
| NPI Number | 1821260654 |
|---|---|
| Provider Enumeration Date | 04/01/2008 |
| Last Update Date | 06/11/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821260654 | NPI | - | NPPES |
| 172820200 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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