| NPI | 1992107122 |
|---|---|
| Doing Business As | PHEASANT RUN DENTAL CENTER |
| Entity Type | Organization |
| Authorized Contact | STEVEN BLACKHURST Dentist 701-577-3333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ND 2210) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: ND 2209) |
| 261QD0000X Clinic/Center, Dental (Licence: NC 2208) | |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2018-06-20 |