Healthcare Provider Details

I. General information

NPI: 1891893723
Provider Name (Legal Business Name): PAUL WESLEY NIEMI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 7TH ST SW SUITE 1
RUGBY ND
58368-2100
US

IV. Provider business mailing address

201 7TH ST SW SUITE 1
RUGBY ND
58368-2100
US

V. Phone/Fax

Practice location:
  • Phone: 701-776-5884
  • Fax:
Mailing address:
  • Phone: 701-776-5884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1763
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: