Provider Demographics
NPI:1932494010
Name:NORTHERN PLAINS DENTAL P.C.
Entity Type:Organization
Organization Name:NORTHERN PLAINS DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-775-4289
Mailing Address - Street 1:1323 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-3427
Mailing Address - Country:US
Mailing Address - Phone:701-775-4289
Mailing Address - Fax:701-775-9596
Practice Address - Street 1:1323 2ND AVE N
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203-3427
Practice Address - Country:US
Practice Address - Phone:701-775-4289
Practice Address - Fax:701-775-9596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1614122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty