Provider Demographics
NPI:1437861556
Name:DYLEN'S CROSSING
Entity Type:Organization
Organization Name:DYLEN'S CROSSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:J
Authorized Official - Last Name:GONSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-690-4184
Mailing Address - Street 1:1142 1ST ST W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-4807
Mailing Address - Country:US
Mailing Address - Phone:701-690-4184
Mailing Address - Fax:
Practice Address - Street 1:1142 1ST ST W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-4807
Practice Address - Country:US
Practice Address - Phone:701-690-4184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service