Individual
DR. MICHAEL DALE EICKMAN
Active
Sole proprietor
Yes
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
Mailing address
PO BOX 655, THIEF RIVER FALLS, MN 56701-0655
(218) 681-2545
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D12920
MN
1223G0001X
General Practice Dentistry
D12920
MN
Other
Enumeration date
06/06/2011
Last updated
06/06/2011
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