Individual
PAUL ROY BENGTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
49 SUMMIT AVE E, BLACKDUCK, MN 56630
(218) 835-4227
(218) 835-7512
Mailing address
PO BOX 308, BLACKDUCK, MN 56630-0308
(218) 835-4227
(218) 835-7512
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7789
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
141818100
—
MN
Enumeration date
04/29/2008
Last updated
04/29/2008
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