Healthcare Provider Details

I. General information

NPI: 1003960410
Provider Name (Legal Business Name): KEVIN S. BJORK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KEVIN S. BJORK DDS

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1929 N WASHINGTON ST
BISMARCK ND
58501-1616
US

IV. Provider business mailing address

1929 N WASHINGTON ST
BISMARCK ND
58501-1616
US

V. Phone/Fax

Practice location:
  • Phone: 701-222-1286
  • Fax: 701-222-1009
Mailing address:
  • Phone: 701-222-1286
  • Fax: 701-222-1009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberND1603
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: