| Organization Name: | ST JOSEPHS COMMUNITY DENTAL CLINIC |
| NPI Number: | 1316014202 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AMY MORRIS (CLINIC MANAGER) |
| Mailing Address: | 205 Pleasant Ave S Park Rapids |
| State: | MN US |
| Postal Code: | 564701434 |
| Phone Number: | 2187324436 |
| Fax Number: | 2187321119 |
| NPI Enumeration Date: | 11/29/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 282NC0060X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Hospitals |
| Taxonomy Classification: | General Acute Care Hospital |
| Taxonomy Specialization: | Critical Access |
| Taxonomy Definition: | |