Provider Demographics
NPI:1376975466
Name:NESS, STEPHANIE NICOLA (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:NICOLA
Last Name:NESS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:JEAN
Other - Last Name:NICOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1015 SOUTH BROADWAY
Mailing Address - Street 2:SUITE 20
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701
Mailing Address - Country:US
Mailing Address - Phone:701-838-1123
Mailing Address - Fax:701-838-1261
Practice Address - Street 1:1015 SOUTH BROADWAY
Practice Address - Street 2:SUITE 20
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701
Practice Address - Country:US
Practice Address - Phone:701-838-1123
Practice Address - Fax:701-838-1261
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2246122300000X
ORD9909122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist