Healthcare Provider Details

I. General information

NPI: 1447117932
Provider Name (Legal Business Name): CHESTER CREEK DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 E 1ST ST
DULUTH MN
55805-2403
US

IV. Provider business mailing address

1324 E 1ST ST
DULUTH MN
55805-2403
US

V. Phone/Fax

Practice location:
  • Phone: 218-724-1332
  • Fax: 218-724-2184
Mailing address:
  • Phone: 218-724-1332
  • Fax: 218-724-2184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DANIEL BELLAMY
Title or Position: OWNER
Credential: DDS
Phone: 218-724-1332