Provider Demographics
NPI:1629222849
Name:DENTAL CARE ASSOCIATES
Entity Type:Organization
Organization Name:DENTAL CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DEETER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-425-4715
Mailing Address - Street 1:701 3RD ST NE
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-2401
Mailing Address - Country:US
Mailing Address - Phone:701-852-5333
Mailing Address - Fax:701-852-5130
Practice Address - Street 1:701 3RD ST NE
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-2401
Practice Address - Country:US
Practice Address - Phone:701-852-5333
Practice Address - Fax:701-852-5130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND20131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty