Provider Demographics
NPI:1336129113
Name:DICKINSON DENTAL CENTER, P.C.
Entity Type:Organization
Organization Name:DICKINSON DENTAL CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:GALSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-483-6999
Mailing Address - Street 1:2 1ST ST W
Mailing Address - Street 2:#215
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-5106
Mailing Address - Country:US
Mailing Address - Phone:701-483-6999
Mailing Address - Fax:701-483-6998
Practice Address - Street 1:2 1ST ST W
Practice Address - Street 2:#215
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5106
Practice Address - Country:US
Practice Address - Phone:701-483-6999
Practice Address - Fax:701-483-6998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1885122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND41280Medicaid