Provider Demographics
NPI:1518425552
Name:TRAVIS J. BJORDAHL, DDS, PLLC
Entity Type:Organization
Organization Name:TRAVIS J. BJORDAHL, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BJORDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-432-5032
Mailing Address - Street 1:PO BOX 592
Mailing Address - Street 2:
Mailing Address - City:MILBANK
Mailing Address - State:SD
Mailing Address - Zip Code:57252-0592
Mailing Address - Country:US
Mailing Address - Phone:605-432-5032
Mailing Address - Fax:605-432-4844
Practice Address - Street 1:1203 E 4TH AVE STE 103
Practice Address - Street 2:
Practice Address - City:MILBANK
Practice Address - State:SD
Practice Address - Zip Code:57252-1558
Practice Address - Country:US
Practice Address - Phone:605-432-5032
Practice Address - Fax:605-432-4844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental