Healthcare Provider Details

I. General information

NPI: 1912616590
Provider Name (Legal Business Name): ALLRED DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E 3RD AVE S
CAVALIER ND
58220-4023
US

IV. Provider business mailing address

PO BOX 635
CAVALIER ND
58220-0635
US

V. Phone/Fax

Practice location:
  • Phone: 701-265-8777
  • Fax: 701-265-8778
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH MARION ALLRED
Title or Position: PRESIDENT
Credential: DDS
Phone: 210-612-3978