| NPI | 1720293442 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOAN POPE Owner 701-642-2656 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ND 1664) |
| Additional Taxonomies | 122300000X Dentist (Licence: ND 1121) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2020-08-22 |