Provider Demographics
NPI:1710529607
Name:OROFACIAL MYOLOGY CONSULTING
Entity Type:Organization
Organization Name:OROFACIAL MYOLOGY CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RDH, COM
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, COM
Authorized Official - Phone:701-430-7605
Mailing Address - Street 1:798 151ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:MAYVILLE
Mailing Address - State:ND
Mailing Address - Zip Code:58257-9206
Mailing Address - Country:US
Mailing Address - Phone:701-430-7605
Mailing Address - Fax:
Practice Address - Street 1:798 151ST AVE NE
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:ND
Practice Address - Zip Code:58257-9206
Practice Address - Country:US
Practice Address - Phone:701-430-7605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental