Individual
THOMAS PETER DIMICH
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
310 RED LAKE BLVD, THIEF RIVER FALLS, MN 56701-2133
(218) 681-2545
(218) 681-2560
Mailing address
104 FOSSE CT, THIEF RIVER FALLS, MN 56701-2605
(218) 681-1088
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7534
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
63233 DI
BLUE CROSS BLUE SHIELD
MN
Enumeration date
05/09/2006
Last updated
07/08/2007
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