Provider Demographics
NPI:1669540936
Name:DENTAL ASSOCIATES OF VALLEY CITY P.C.
Entity type:Organization
Organization Name:DENTAL ASSOCIATES OF VALLEY CITY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:G
Authorized Official - Last Name:ZWICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-845-4221
Mailing Address - Street 1:202 CENTRAL AVE S
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58072-3325
Mailing Address - Country:US
Mailing Address - Phone:701-845-4221
Mailing Address - Fax:
Practice Address - Street 1:202 CENTRAL AVE S
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072-3325
Practice Address - Country:US
Practice Address - Phone:701-845-4221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND13541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty