# PARK RIVER DENTAL, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Park River Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174666119
- **Authorized official:** DR. BRIAN JAMES LARSON DDS (OWNER/DENTIST PRESIDENT)
- **Authorized official phone:** (701) 284-6131

## Contact information

- **Practice address:** 418 BRIGGS AVENUE, PARK RIVER, ND 58270-0662
- **Practice address phone:** (701) 284-6131
- **Mailing address:** PO BOX 662, PARK RIVER, ND 58270-0662
- **Mailing address phone:** (701) 284-6131

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 1355 | ND | — |
| 1223G0001X | General Practice Dentistry | 1805 | ND | Yes |

## Other

- **Enumeration date:** 02/15/2007
- **Last updated:** 06/03/2014