| NPI | 1578791117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA LEIGH BOYER Office Manager 701-232-6983 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: ND 2056) |
| 261QD0000X Clinic/Center Dental | |
| 1223G0001X Dentist General Practice (Licence: ND 1796) | |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2022-08-15 |