Fond Du Lac Reservation Business Committe

NPI #1063723138 in Cloquet, Minnesota

Provider Information

NPI Number: 1063723138
Entity Type: Organization
Organization Name: Fond Du Lac Reservation Business Committe
Subpart: Yes (part of a larger organization)
Parent Organization: FOND DU LAC RESERVATION BUSINESS COMMITTEE
Primary Specialty: Clinic/Center - Dental
Enumeration Date: Jun 23, 2010
Last Updated: Jun 23, 2010

Practice Location

Address: 927 TRETTEL LANE
Address 2: FOND DU LAC HUMAN SERVICES DIVISION DENTAL CLINIC
City: Cloquet
State: Minnesota
ZIP Code: 55720
Phone: (218) 879-1227

Authorized Official

Name: KAREN R DIVER
Title: CHAIRWOMAN
Phone: (218) 879-4593

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Dental — Dental	261QD0000X	Primary

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