Organization
FAIRMONT FAMILY DENTISTRY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JON THOMAS ERISKSON (PRESIDENT)
(507) 238-2812
Entity
Organization
Contact information
Practice address
202 N PARK ST, FAIRMONT, MN 56031-2824
(507) 238-2818
(507) 235-8914
Mailing address
202 N PARK ST, FAIRMONT, MN 56031-2824
(507) 238-2818
(507) 235-8914
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D10871
MN
Other
Enumeration date
04/15/2008
Last updated
04/15/2008
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