Provider Demographics
NPI:1326515776
Name:MC DENTAL CORPORATION, PC
Entity Type:Organization
Organization Name:MC DENTAL CORPORATION, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BROCK
Authorized Official - Middle Name:
Authorized Official - Last Name:CASPERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:701-774-1879
Mailing Address - Street 1:708 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-5320
Mailing Address - Country:US
Mailing Address - Phone:701-774-1879
Mailing Address - Fax:
Practice Address - Street 1:708 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-5320
Practice Address - Country:US
Practice Address - Phone:701-774-1879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental