Provider Demographics
NPI:1366734295
Name:DEMERS DENTAL
Entity type:Organization
Organization Name:DEMERS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:STADEM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-773-7474
Mailing Address - Street 1:706 DEMERS AVE
Mailing Address - Street 2:
Mailing Address - City:EAST GRAND FORKS
Mailing Address - State:MN
Mailing Address - Zip Code:56721-1842
Mailing Address - Country:US
Mailing Address - Phone:218-773-7474
Mailing Address - Fax:218-773-8859
Practice Address - Street 1:706 DEMERS AVE
Practice Address - Street 2:
Practice Address - City:EAST GRAND FORKS
Practice Address - State:MN
Practice Address - Zip Code:56721-1842
Practice Address - Country:US
Practice Address - Phone:218-773-7474
Practice Address - Fax:218-773-8859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty