Healthcare Provider Details

I. General information

NPI: 1730356833
Provider Name (Legal Business Name): DUSTIN ALLEN HOLLEVOET DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 W TURNPIKE AVE
BISMARCK ND
58501-8115
US

IV. Provider business mailing address

1165 W TURNPIKE AVE
BISMARCK ND
58501-8115
US

V. Phone/Fax

Practice location:
  • Phone: 612-625-6444
  • Fax:
Mailing address:
  • Phone: 701-751-1981
  • Fax: 701-751-2237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2072
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: