Organization
BLACKDUCK DENTAL CLINIC PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT JOSEPH LARSON DDS (PRESIDENT)
(218) 835-4227
Entity
Organization
Contact information
Practice address
49 SUMMIT AVE. E., BLACKDUCK, MN 56630-9727
(218) 835-4227
Mailing address
PO BOX 308, BLACKDUCK, MN 56630-0308
(218) 835-4227
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D12251
MN
Other
Enumeration date
01/13/2012
Last updated
01/13/2012
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