Provider Demographics
NPI:1689117830
Name:PRAIRIE ROSE FAMILY DENTISTS
Entity Type:Organization
Organization Name:PRAIRIE ROSE FAMILY DENTISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-223-8262
Mailing Address - Street 1:121 E FRONT AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5589
Mailing Address - Country:US
Mailing Address - Phone:701-223-1194
Mailing Address - Fax:
Practice Address - Street 1:900 E CALGARY AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-5616
Practice Address - Country:US
Practice Address - Phone:701-223-8262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty