Blackduck Dental Clinic Psc

NPI #1376814939 in Blackduck, Minnesota

Provider Information

NPI Number
1376814939
Entity Type
Organization
Organization Name
Blackduck Dental Clinic Psc
Primary Specialty
Dentist - General Practice
Enumeration Date
Jan 13, 2012
Last Updated
Jan 13, 2012

Practice Location

Address
49 SUMMIT AVE. E.
ZIP Code
56630-9727
Phone
(218) 835-4227

Authorized Official

Name
DR. SCOTT JOSEPH LARSON, DDS
Title
PRESIDENT
Phone
(218) 835-4227

Specialties & Taxonomy Codes

Specialty
Dentist - General PracticeGeneral Practice

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