Provider Demographics
NPI:1073523783
Name:CLAUSNITZER, BLAINE T (DDS)
Entity Type:Individual
Prefix:DR
First Name:BLAINE
Middle Name:T
Last Name:CLAUSNITZER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 COLLEGE DR
Mailing Address - Street 2:STE 108
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501
Mailing Address - Country:US
Mailing Address - Phone:701-255-0586
Mailing Address - Fax:701-255-2186
Practice Address - Street 1:1110 COLLEGE DR
Practice Address - Street 2:STE 108
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501
Practice Address - Country:US
Practice Address - Phone:701-255-0586
Practice Address - Fax:701-255-2186
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND9018041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND41313Medicaid