Provider Demographics
NPI:1336107804
Name:KRIEG, MORTON LEWIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MORTON
Middle Name:LEWIS
Last Name:KRIEG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:58601-3936
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:58601-3936
Practice Address - Country:US
Practice Address - Phone:701-483-8113
Practice Address - Fax:701-483-8202
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1847122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND41180Medicaid