Healthcare Provider Details

I. General information

NPI: 1043321334
Provider Name (Legal Business Name): DERIK HOERNER, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 S. 7TH STREET
BISMARCK ND
58504-6531
US

IV. Provider business mailing address

1004 S. 7TH STREET
BISMARCK ND
58504-6531
US

V. Phone/Fax

Practice location:
  • Phone: 701-390-1920
  • Fax: 701-255-4055
Mailing address:
  • Phone: 701-390-1920
  • Fax: 701-255-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2057
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1387
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1427
License Number StateND

VIII. Authorized Official

Name: DR. DERIK HOERNER
Title or Position: DENTIST
Credential: D.D.S
Phone: 701-955-5111