| Brainerd Dental Clinic | |
|
11615 State Ave. Brainerd MN 56401 | |
| (218) 855-8600 | |
| Not Available |
| Full Name | Brainerd Dental Clinic |
|---|---|
| Speciality | Dentist - Dental Public Health |
| Location | 11615 State Ave., Brainerd, Minnesota |
| Authorized Official Name and Position | Wade Richard Brost (MN DHS, DCT EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6514313404 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Brainerd Dental Clinic 3200 Labore Rd. Ste. 104 Vadnais Heights MN 55110-5186 Ph: (651) 431-5995 | Brainerd Dental Clinic 11615 State Ave. Brainerd MN 56401 Ph: (218) 855-8600 |
| NPI Number | 1467508226 |
|---|---|
| Provider Enumeration Date | 01/26/2007 |
| Last Update Date | 06/05/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467508226 | NPI | - | NPPES |
| 970826000 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223D0001X | Dentist - Dental Public Health | (* (Not Available)) | Primary |
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