Provider Demographics
NPI:1043272529
Name:DAKOTA ENT, PC
Entity Type:Organization
Organization Name:DAKOTA ENT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:BUELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-223-1967
Mailing Address - Street 1:810 E ROSSER AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4463
Mailing Address - Country:US
Mailing Address - Phone:701-223-1967
Mailing Address - Fax:701-223-6597
Practice Address - Street 1:810 E ROSSER AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4463
Practice Address - Country:US
Practice Address - Phone:701-223-1967
Practice Address - Fax:701-223-6597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4128174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND014275Medicaid
NDN711190Medicare ID - Type Unspecified
NDD25776Medicare UPIN