Provider Demographics
NPI:1033893946
Name:PEACE GARDEN DENTAL PLLC
Entity Type:Organization
Organization Name:PEACE GARDEN DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SWATI
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-770-5670
Mailing Address - Street 1:1383 21ST AVE N STE B
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-1841
Mailing Address - Country:US
Mailing Address - Phone:701-515-4901
Mailing Address - Fax:701-515-4902
Practice Address - Street 1:1383 21ST AVE N STE B
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-1841
Practice Address - Country:US
Practice Address - Phone:701-515-4901
Practice Address - Fax:701-515-4902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty