Provider Demographics
NPI:1558034777
Name:BISMARCK DENTISTRY PC
Entity Type:Organization
Organization Name:BISMARCK DENTISTRY PC
Other - Org Name:PLAZA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:VAN BUSKIRK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-751-8081
Mailing Address - Street 1:4401 COLEMAN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-1371
Mailing Address - Country:US
Mailing Address - Phone:701-751-8081
Mailing Address - Fax:701-751-0836
Practice Address - Street 1:620 19TH ST W STE 200
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-2972
Practice Address - Country:US
Practice Address - Phone:701-502-0060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BISMARCK DENTISTRY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty