Organization
RIVER CITY DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEDRIC MCBROOM (OWNER)
(320) 252-6233
Entity
Organization
Contact information
Practice address
1201 MAINE PRAIRIE RD, SAINT CLOUD, MN 56301-4881
(320) 252-6233
(320) 252-9261
Mailing address
PO BOX 280, SAINT CLOUD, MN 56302-0280
(320) 252-6233
(320) 252-9261
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
11/08/2006
Last updated
08/22/2020
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