| NPI | 1174666119 |
|---|---|
| Doing Business As | PARK RIVER DENTAL |
| Entity Type | Organization |
| Authorized Contact | BRIAN JAMES LARSON Owner/Dentist President 701-284-6131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ND 1805) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ND 1355) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2014-06-03 |