Provider Demographics
NPI:1184061012
Name:CONCEPT DENTISTRY, PC VALLEY CITY
Entity type:Organization
Organization Name:CONCEPT DENTISTRY, PC VALLEY CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:BULIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-845-2180
Mailing Address - Street 1:1150 WEST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58072
Mailing Address - Country:US
Mailing Address - Phone:701-845-2180
Mailing Address - Fax:
Practice Address - Street 1:1150 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072
Practice Address - Country:US
Practice Address - Phone:701-845-2180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-01
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2079261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental