Provider Demographics
NPI:1326452335
Name:KRIEG FAMILY DENTAL
Entity Type:Organization
Organization Name:KRIEG FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MORTON
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:KRIEG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-483-8113
Mailing Address - Street 1:188 OSBORN DR
Mailing Address - Street 2:P.O. BOX 1096
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-3960
Mailing Address - Country:US
Mailing Address - Phone:701-483-8113
Mailing Address - Fax:701-483-8202
Practice Address - Street 1:188 OSBORN DR
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-3960
Practice Address - Country:US
Practice Address - Phone:701-483-8113
Practice Address - Fax:701-483-8202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1847122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND41180Medicaid