Provider Demographics
NPI:1609630425
Name:MICHAEL EVANOFF DMD PLLC
Entity Type:Organization
Organization Name:MICHAEL EVANOFF DMD PLLC
Other - Org Name:MICHAEL EVANOFF DMD PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARI DOMINI
Authorized Official - Middle Name:
Authorized Official - Last Name:ABERLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-852-3222
Mailing Address - Street 1:1000 31ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-7403
Mailing Address - Country:US
Mailing Address - Phone:701-852-3222
Mailing Address - Fax:701-852-2767
Practice Address - Street 1:1000 31ST AVE SW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-7403
Practice Address - Country:US
Practice Address - Phone:701-852-3222
Practice Address - Fax:701-852-2767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty