Provider Demographics
NPI:1891893723
Name:NIEMI, PAUL WESLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WESLEY
Last Name:NIEMI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
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:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND17631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND512144OtherBCBS
876772OtherCONCORDIA
ND41004Medicaid