Provider Demographics
NPI:1033512660
Name:DGB DENTAL
Entity Type:Organization
Organization Name:DGB DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:BRANT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-352-0730
Mailing Address - Street 1:15 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-2313
Mailing Address - Country:US
Mailing Address - Phone:701-352-0730
Mailing Address - Fax:701-352-0902
Practice Address - Street 1:15 E 7TH ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-2313
Practice Address - Country:US
Practice Address - Phone:701-352-0730
Practice Address - Fax:701-352-0902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1617261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental