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Organization
PELICAN DENTAL
Active
Organization
PELICAN DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID MICHAEL DITCH DDS (OWNER/DENTIST)
(218) 863-5858
Entity
Organization
Contact information
Practice address
28 E MILL AVE STE 1, PELICAN RAPIDS, MN 56572-4229
(218) 863-5858
(218) 863-1143
Mailing address
PO BOX 342, PELICAN RAPIDS, MN 56572-0342
(218) 863-5858
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D10376
MN
Other
Enumeration date
05/15/2018
Last updated
05/15/2018
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