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Organization
BLACK BEAR FAMILY DENTAL PC
Active
Organization
BLACK BEAR FAMILY DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VERONICA COOPER DDS (PRESIDENT)
(218) 444-2004
Entity
Organization
Contact information
Practice address
1628 30TH ST NW, BEMIDJI, MN 56601-4690
(218) 444-2004
Mailing address
1628 30TH ST NW, BEMIDJI, MN 56601-4690
(218) 444-2004
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
11/06/2018
Last updated
11/06/2018
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