Provider Demographics
NPI:1932599081
Name:DEETER AND DEETER DENTISTRY PARTNERSHIP
Entity Type:Organization
Organization Name:DEETER AND DEETER DENTISTRY PARTNERSHIP
Other - Org Name:GARRISON DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:DEETER
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:701-463-2884
Mailing Address - Street 1:51 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:ND
Mailing Address - Zip Code:58540-7166
Mailing Address - Country:US
Mailing Address - Phone:701-463-2884
Mailing Address - Fax:701-463-2894
Practice Address - Street 1:51 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:ND
Practice Address - Zip Code:58540-7166
Practice Address - Country:US
Practice Address - Phone:701-463-2884
Practice Address - Fax:701-463-2894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty