Healthcare Provider Details

I. General information

NPI: 1508784786
Provider Name (Legal Business Name): BAILEY BRIAN VAN BUSKIRK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 19TH ST W STE 200
DICKINSON ND
58601-2972
US

IV. Provider business mailing address

620 19TH ST W STUDIO 200
DICKINSON ND
58601-2972
US

V. Phone/Fax

Practice location:
  • Phone: 701-502-0060
  • Fax: 701-999-9005
Mailing address:
  • Phone: 701-502-0060
  • Fax: 701-999-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2596
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: