Provider Demographics
NPI:1316044761
Name:DAKOTA FAMILY DENTAL
Entity Type:Organization
Organization Name:DAKOTA FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-258-7900
Mailing Address - Street 1:1929 N. WASHINGTON ST.
Mailing Address - Street 2:PO BOX 7039
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58507-7039
Mailing Address - Country:US
Mailing Address - Phone:701-258-7900
Mailing Address - Fax:701-250-0557
Practice Address - Street 1:1929 N. WASHINGTON ST.
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58507-7039
Practice Address - Country:US
Practice Address - Phone:701-258-7900
Practice Address - Fax:701-250-0557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty