Healthcare Provider Details

I. General information

NPI: 1952348013
Provider Name (Legal Business Name): DAKOTA SURGERY & LASER CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 E SWEET AVE
BISMARCK ND
58504-5658
US

IV. Provider business mailing address

200 S 5TH ST
BISMARCK ND
58504-5675
US

V. Phone/Fax

Practice location:
  • Phone: 701-222-4900
  • Fax: 701-222-4999
Mailing address:
  • Phone: 701-222-3937
  • Fax: 701-222-8805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALEESA A BRORBY
Title or Position: ADMINISTRATOR
Credential:
Phone: 701-222-3937