Provider Demographics
NPI:1003960410
Name:BJORK, KEVIN S (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:S
Last Name:BJORK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:KEVIN
Other - Middle Name:S
Other - Last Name:BJORK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1929 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1616
Mailing Address - Country:US
Mailing Address - Phone:701-222-1286
Mailing Address - Fax:701-222-1009
Practice Address - Street 1:1929 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-1616
Practice Address - Country:US
Practice Address - Phone:701-222-1286
Practice Address - Fax:701-222-1009
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDND1603122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist