Organization
THOMAS P. DIMICH, DDS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS PETER DIMICH DDS (PRESIDENT)
(218) 681-2545
Entity
Organization
Contact information
Practice address
310 RED LAKE BLVD., THIEF RIVER FALLS, MN 56701-2133
(218) 681-2545
(218) 681-2560
Mailing address
PO BOX 655, THIEF RIVER FALLS, MN 56701-2133
(218) 681-2545
(218) 681-2560
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7534
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
376513000
MN HEALTHCARE PROGRAM
MN
Enumeration date
02/15/2011
Last updated
02/15/2011
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