| NPI | 1154575199 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDOLPH RICHARD PITZER Owner Pres 701-774-0259 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: ND 1628) |
| Additional Taxonomies | 122300000X Dentist (Licence: ND 2010) |
| Enumeration Date | 2008-11-04 |
| Last Update Date | 2008-11-04 |