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Organization
FOND DU LAC RESERVATION BUSINESS COMMITTE
Active
Organization
FOND DU LAC RESERVATION BUSINESS COMMITTE
Active
Parent organization
FOND DU LAC RESERVATION BUSINESS COMMITTEE
Other names
Fond du Lac Human Services Division Dental Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
FOND DU LAC RESERVATION BUSINESS COMMITTEE
Authorized official
KAREN R DIVER (CHAIRWOMAN)
(218) 879-4593
Entity
Organization
Contact information
Practice address
927 TRETTEL LANE, FOND DU LAC HUMAN SERVICES DIVISION DENTAL CLINIC, CLOQUET, MN 55720
(218) 879-1227
(218) 878-3755
Mailing address
927 TRETTEL LANE, FOND DU LAC HUMAN SERVICES DIVISION DENTAL CLINIC, CLOQUET, MN 55720
(218) 879-1227
(218) 878-3755
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
666815100
—
MN
Enumeration date
06/23/2010
Last updated
06/23/2010
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