Healthcare Provider Details

I. General information

NPI: 1609630425
Provider Name (Legal Business Name): MICHAEL EVANOFF DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 31ST AVE SW
MINOT ND
58701-7403
US

IV. Provider business mailing address

1000 31ST AVE SW
MINOT ND
58701-7403
US

V. Phone/Fax

Practice location:
  • Phone: 701-852-3222
  • Fax: 701-852-2767
Mailing address:
  • Phone: 701-852-3222
  • Fax: 701-852-2767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARI DOMINI ABERLE
Title or Position: OFFICE MANAGER
Credential:
Phone: 701-852-3222