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Organization
DIPAUL DENTAL, PC
Active
Organization
DIPAUL DENTAL, PC
Active
Other names
Aspen Dental
Organization subpart
No
Provider details
NPI number
Authorized official
KIM VAN CAMP (PROVIDER ENROLLMENT SPECIALIST)
(315) 454-6000
Entity
Organization
Contact information
Practice address
2219 PAUL BUNYAN DR NW STE 6-7, BEMIDJI, MN 56601-6188
(218) 751-2659
(218) 751-1806
Mailing address
PO BOX 3189, SYRACUSE, NY 13220-3189
(315) 454-6000
(866) 273-8204
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
13499
MN
Other
Enumeration date
04/07/2015
Last updated
04/07/2015
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