Healthcare Provider Details

I. General information

NPI: 1407523939
Provider Name (Legal Business Name): DR. ODREY BECHTEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 GREENSBORO DR STE 103
BISMARCK ND
58503-5413
US

IV. Provider business mailing address

3231 GREENSBORO DR STE 103
BISMARCK ND
58503-5413
US

V. Phone/Fax

Practice location:
  • Phone: 773-438-3960
  • Fax: 763-438-3960
Mailing address:
  • Phone: 773-438-3960
  • Fax: 763-438-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2599
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: