Organization
RANGE FAMILY DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON OLAI BERG DDS (OWNER)
(218) 741-0089
Entity
Organization
Contact information
Practice address
302 CHESTNUT ST, SUITE 200, VIRGINIA, MN 55792-2541
(218) 741-0089
Mailing address
302 CHESTNUT ST, SUITE 200, VIRGINIA, MN 55792-2541
(218) 741-0089
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D12816
MN
Other
Enumeration date
02/26/2015
Last updated
02/26/2015
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