Organization
PARK RIVER DENTAL, PC
Active
Other names
Park River Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN JAMES LARSON DDS (OWNER/DENTIST PRESIDENT)
(701) 284-6131
Entity
Organization
Contact information
Practice address
418 BRIGGS AVENUE, PARK RIVER, ND 58270-0662
(701) 284-6131
Mailing address
PO BOX 662, PARK RIVER, ND 58270-0662
(701) 284-6131
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
1355
ND
1223G0001X
General Practice Dentistry
Primary
1805
ND
Other
Enumeration date
02/15/2007
Last updated
06/03/2014
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