Provider Demographics
NPI:1649338377
Name:BRIDGING THE DENTAL GAP INC
Entity type:Organization
Organization Name:BRIDGING THE DENTAL GAP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-221-0518
Mailing Address - Street 1:1223 S 12TH ST
Mailing Address - Street 2:STE 1 BRIDGING THE DENTAL GAP INC
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504
Mailing Address - Country:US
Mailing Address - Phone:701-221-0518
Mailing Address - Fax:701-221-0537
Practice Address - Street 1:1223 S 12TH ST
Practice Address - Street 2:STE 1
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504
Practice Address - Country:US
Practice Address - Phone:701-221-0518
Practice Address - Fax:701-221-0537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND41340Medicaid