Provider Demographics
NPI:1063628592
Name:AXVIG, DANIEL DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:DEAN
Last Name:AXVIG
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 1:301 E FRONT AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5601
Mailing Address - Country:US
Mailing Address - Phone:701-223-5500
Mailing Address - Fax:701-222-2218
Practice Address - Street 1:301 E FRONT AVE STE 105
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5601
Practice Address - Country:US
Practice Address - Phone:701-223-5500
Practice Address - Fax:701-222-2218
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND16891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice