Provider Demographics
NPI:1457843591
Name:DELL RAPIDS DENTAL
Entity Type:Organization
Organization Name:DELL RAPIDS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:P
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:320-234-7095
Mailing Address - Street 1:10955 ANGLER TRL
Mailing Address - Street 2:
Mailing Address - City:GREY EAGLE
Mailing Address - State:MN
Mailing Address - Zip Code:56336-4766
Mailing Address - Country:US
Mailing Address - Phone:320-247-0953
Mailing Address - Fax:
Practice Address - Street 1:108 W 4TH ST
Practice Address - Street 2:
Practice Address - City:DELL RAPIDS
Practice Address - State:SD
Practice Address - Zip Code:57022-1508
Practice Address - Country:US
Practice Address - Phone:605-428-5471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty