Healthcare Provider Details

I. General information

NPI: 1265822647
Provider Name (Legal Business Name): ANTHONY DOSCH LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 22ND AVE NW
MINOT ND
58703-1071
US

IV. Provider business mailing address

PO BOX 2209
MINOT ND
58702-2209
US

V. Phone/Fax

Practice location:
  • Phone: 701-852-3552
  • Fax: 701-857-0756
Mailing address:
  • Phone: 701-852-3552
  • Fax: 701-857-0756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4734
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: