Healthcare Provider Details

I. General information

NPI: 1609977354
Provider Name (Legal Business Name): DARIN L EDEEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 CENTER AVE WEST
DILWORTH MN
56529
US

IV. Provider business mailing address

802 CENTER AVE W
DILWORTH MN
56529-1339
US

V. Phone/Fax

Practice location:
  • Phone: 218-287-2938
  • Fax: 218-287-0317
Mailing address:
  • Phone: 218-287-2938
  • Fax: 218-287-0317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD11241
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: