Healthcare Provider Details

I. General information

NPI: 1336129113
Provider Name (Legal Business Name): DICKINSON DENTAL CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 1ST ST W #215
DICKINSON ND
58601-5106
US

IV. Provider business mailing address

2 1ST ST W #215
DICKINSON ND
58601-5106
US

V. Phone/Fax

Practice location:
  • Phone: 701-483-6999
  • Fax: 701-483-6998
Mailing address:
  • Phone: 701-483-6999
  • Fax: 701-483-6998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1885
License Number StateND

VIII. Authorized Official

Name: DR. SHANNON DEAN GALSTER
Title or Position: DENTIST
Credential: D.D.S.
Phone: 701-483-6999