Organization
GREAT RIVER DENTISTRY OF BEMIDJI, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS R WILLIAMS DDS (OWNER)
(218) 751-4216
Entity
Organization
Contact information
Practice address
3622 MOBERG DR NW, BEMIDJI, MN 56601-5644
(218) 751-4216
(218) 444-6057
Mailing address
PO BOX 1005, BEMIDJI, MN 56619-1005
(218) 751-4216
(218) 444-6057
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
172820200
—
MN
Enumeration date
04/01/2008
Last updated
06/11/2008
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