Provider Demographics
NPI:1003027517
Name:MIDSTOKKE, STEVEN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:MIDSTOKKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 W CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1301
Mailing Address - Country:US
Mailing Address - Phone:701-226-4855
Mailing Address - Fax:
Practice Address - Street 1:1223 S 12TH ST STE 1
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-6626
Practice Address - Country:US
Practice Address - Phone:701-221-0518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND19921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice