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 |