Provider Demographics
NPI:1649400797
Name:RUGBY DENTAL OFFICE, P.C.
Entity Type:Organization
Organization Name:RUGBY DENTAL OFFICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SANTJER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-776-5884
Mailing Address - Street 1:201 7TH ST. SW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RUGBY
Mailing Address - State:ND
Mailing Address - Zip Code:58368-2100
Mailing Address - Country:US
Mailing Address - Phone:701-776-5884
Mailing Address - Fax:701-776-5244
Practice Address - Street 1:201 7TH ST. SW
Practice Address - Street 2:SUITE 1
Practice Address - City:RUGBY
Practice Address - State:ND
Practice Address - Zip Code:58368-2100
Practice Address - Country:US
Practice Address - Phone:701-776-5884
Practice Address - Fax:701-776-2835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1457947Medicaid