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General NPI Number Information
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NPI Number | 1164522306
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Entity Type | Organization
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Legal Business Name | GOOSE RIVER DENTAL ASSOC., PC
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 37 1/2 MAIN ST E
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City | MAYVILLE
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State | ND
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Zip | 58257
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Country | US
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Telephone | 701-788-4064
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Fax | 701-788-9090
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Provider Business Mailing Address
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Address Line | 37 1/2 MAIN ST E
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City | MAYVILLE
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State | ND
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Zip | 58257
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Country | US
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Telephone | 701-788-4064
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Fax | 701-788-9090
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT C LAUF JR.
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Credential | DDS
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Telephone | 701-788-4064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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