Provider Demographics
NPI:1942579081
Name:PRAIRIE DENTAL INC
Entity Type:Organization
Organization Name:PRAIRIE DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SARSLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-523-3255
Mailing Address - Street 1:PO BOX 710
Mailing Address - Street 2:
Mailing Address - City:BOWMAN
Mailing Address - State:ND
Mailing Address - Zip Code:58623-0710
Mailing Address - Country:US
Mailing Address - Phone:701-523-3255
Mailing Address - Fax:701-523-5742
Practice Address - Street 1:608 HIGHWAY 12 W
Practice Address - Street 2:
Practice Address - City:BOWMAN
Practice Address - State:ND
Practice Address - Zip Code:58623-4507
Practice Address - Country:US
Practice Address - Phone:701-523-3255
Practice Address - Fax:701-523-5742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2101122300000X
124Q00000X, 126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty