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Organization
BLACKDUCK DENTAL CLINIC
Active
Organization
BLACKDUCK DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL R BENGTSON DDS (DENTIST)
(218) 835-4227
Entity
Organization
Contact information
Practice address
49 SUMMIT AVE. SE, BLACKDUCK, MN 56630
(218) 835-4227
(218) 835-7512
Mailing address
PO BOX 308, BLACKDUCK, MN 56630-0308
(218) 835-4227
(218) 835-7512
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7789
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
81202BE
BLUE CROSS BLUE SHIELD
MN
Enumeration date
10/26/2006
Last updated
07/21/2022
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