| NPI | 1043514367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS GLEN FELLMAN President 701-232-8884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ND 1493) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: ND 1843) |
| 261QD0000X Clinic/Center, Dental (Licence: ND 2068) | |
| Enumeration Date | 2010-12-29 |
| Last Update Date | 2010-12-29 |