Organization
PINE RIVER DENTAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN M COLLIER D.D.S (OWNER)
(218) 587-4437
Entity
Organization
Contact information
Practice address
203 PARK AVE W, PINE RIVER, MN 56474-4495
(218) 587-4437
Mailing address
PO BOX 650, PINE RIVER, MN 56474-0650
(218) 587-4437
(218) 587-4479
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
7903
MN
261QD0000X
Dental Clinic/Center
Primary
8357
MN
261QD0000X
Dental Clinic/Center
D7197
MN
Other
Enumeration date
06/05/2008
Last updated
10/29/2008
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