Great River Dentistry Of Bemidji, PLLC
Clinic/Center, Dental in Bemidji, MN. Organization (NPI-2).
NPI number1982156147
StatusActive
Last updated in NPPESNov 3, 2016
Details
- NPI
- 1982156147
- Entity type
- Organization (NPI-2)
- Legal business name
- Great River Dentistry Of Bemidji, PLLC
- Organization subpart
- No
- Enumeration date
- Nov 3, 2016
- Last updated
- Nov 3, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | MN | Yes |
Practice location
3622 Moberg Dr NwBemidji, MN 56601-5644
Phone 218-751-4216 · Fax 218-444-6057
Mailing address
Po Box 1005Bemidji, MN 56619-1005
Phone 218-751-4216 · Fax 218-444-6057
Authorized official
Baret Williams-Furfaro
Owner DDS
2187514216
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