Healthcare Provider Details

I. General information

NPI: 1417153115
Provider Name (Legal Business Name): JAMES MICHAEL UKESTAD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 FIFTH AVENUE SOUTHEAST
JAMESTOWN ND
58401
US

IV. Provider business mailing address

2107 FOURTH STREET NORTHEAST
JAMESTOWN ND
58401
US

V. Phone/Fax

Practice location:
  • Phone: 701-252-0141
  • Fax:
Mailing address:
  • Phone: 701-251-1791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1756
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: