Provider Demographics
NPI:1295913622
Name:MCDONALD-GALSTAD, LTD
Entity type:Organization
Organization Name:MCDONALD-GALSTAD, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GUNDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-773-3010
Mailing Address - Street 1:1421 CENTRAL AVE NW
Mailing Address - Street 2:
Mailing Address - City:E GRAND FORKS
Mailing Address - State:MN
Mailing Address - Zip Code:56721-1617
Mailing Address - Country:US
Mailing Address - Phone:218-773-3010
Mailing Address - Fax:218-773-9780
Practice Address - Street 1:1421 CENTRAL AVE NW
Practice Address - Street 2:
Practice Address - City:E GRAND FORKS
Practice Address - State:MN
Practice Address - Zip Code:56721-1617
Practice Address - Country:US
Practice Address - Phone:218-773-3010
Practice Address - Fax:218-773-9780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND040679Medicaid