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General NPI Number Information
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NPI Number | 1033306998
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Entity Type | Organization
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Legal Business Name | AESTHETIC CENTER OF PLASTIC SURGERY
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 115 W CENTURY AVE SUITE B
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City | BISMARCK
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State | ND
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Zip | 58503-1403
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Country | US
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Telephone | 701-255-3311
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Fax | 701-255-2255
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Provider Business Mailing Address
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Address Line | 115 W CENTURY AVE SUITE B
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City | BISMARCK
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State | ND
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Zip | 58503-1403
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Country | US
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Telephone | 701-255-3311
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Fax | 701-255-2255
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. RICK L PAULSON
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Credential | M.D.
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Telephone | 701-255-3311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | BP4905482
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License Number State | ND
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