Provider Demographics
NPI:1235695958
Name:BIG BEAR DENTISTRY
Entity Type:Organization
Organization Name:BIG BEAR DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:ZMOOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-431-4015
Mailing Address - Street 1:17 SCRAMBLE ST
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-7495
Mailing Address - Country:US
Mailing Address - Phone:319-431-4015
Mailing Address - Fax:
Practice Address - Street 1:2615 ELK DR STE 1
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-1200
Practice Address - Country:US
Practice Address - Phone:701-839-4440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty