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Organization
PARK RIVER DENTAL, PC
Active
Organization
PARK RIVER DENTAL, PC
Active
Other names
Park River Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN JAMES LARSON DDS (OWNER/DENTIST PRESIDENT)
(701) 284-6131
Entity
Organization
Contact information
Practice address
418 BRIGGS AVENUE, PARK RIVER, ND 58270-0662
(701) 284-6131
Mailing address
PO BOX 662, PARK RIVER, ND 58270-0662
(701) 284-6131
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
1355
ND
1223G0001X
General Practice Dentistry
Primary
1805
ND
Other
Enumeration date
02/15/2007
Last updated
06/03/2014
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