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Organization
BALATON DENTAL CLINIC,INC
Active
Organization
BALATON DENTAL CLINIC,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD WALLACE BROWN DDS (OWNER/DENTIST)
(507) 734-2251
Entity
Organization
Contact information
Practice address
123 3RD ST, BALATON, MN 56115-9451
(507) 734-2251
(507) 734-2077
Mailing address
123 3RD ST, P.O.BOX 186, BALATON, MN 56115-9451
(507) 734-2251
(507) 734-2077
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10227
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
996822900
MEDICAL ASSISTANCE
MN
Enumeration date
10/09/2013
Last updated
10/09/2013
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