Organization
PRAIRIE DENTAL CENTERS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID RESNICK DDS (CFO)
(218) 784-7119
Entity
Organization
Contact information
Practice address
200 E MAIN ST, ADA, MN 56510
(218) 784-7119
(218) 784-2381
Mailing address
200 E MAIN ST, ADA, MN 56510
(218) 784-7119
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
10680
MN
1223G0001X
General Practice Dentistry
Primary
10681
MN
Other
Enumeration date
12/11/2006
Last updated
08/22/2020
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