Provider Demographics
NPI:1952466559
Name:NEIL DABY DDM LTD
Entity Type:Organization
Organization Name:NEIL DABY DDM LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:DABY
Authorized Official - Suffix:
Authorized Official - Credentials:DDM
Authorized Official - Phone:701-352-0730
Mailing Address - Street 1:15 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-2313
Mailing Address - Country:US
Mailing Address - Phone:701-352-0730
Mailing Address - Fax:701-352-0902
Practice Address - Street 1:15 E 7TH ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-2313
Practice Address - Country:US
Practice Address - Phone:701-352-0730
Practice Address - Fax:701-352-0730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1589122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND40342Medicaid