Provider Demographics
NPI:1558657437
Name:MIDSTOKKE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:MIDSTOKKE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MIDSTOKKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-255-0475
Mailing Address - Street 1:2940 N 19TH ST
Mailing Address - Street 2:SUITE2
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-5393
Mailing Address - Country:US
Mailing Address - Phone:701-255-0475
Mailing Address - Fax:701-258-4096
Practice Address - Street 1:2940 N 19TH ST
Practice Address - Street 2:SUITE2
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-5393
Practice Address - Country:US
Practice Address - Phone:701-255-0475
Practice Address - Fax:701-258-4096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1992261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental