| NPI | 1124484464 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEGAN BREND Partner 701-255-2467 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ND 2137) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: ND 1418) |
| 1223P0700X Dentist Prosthodontics (Licence: ND 2140) | |
| Enumeration Date | 2015-12-31 |
| Last Update Date | 2016-01-19 |