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General NPI Number Information
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NPI Number | 1215465372
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Entity Type | Organization
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Legal Business Name | AMUNDSON DENTAL ASSOCIATES
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Dates
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Enumeration Date | 06/01/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2600 DEMERS AVE STE 107
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City | GRAND FORKS
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State | ND
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Zip | 58201-4100
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Country | US
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Telephone | 701-772-0171
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Fax | 701-772-3138
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Provider Business Mailing Address
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Address Line | 2600 DEMERS AVE STE 107
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City | GRAND FORKS
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State | ND
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Zip | 58201-4100
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Country | US
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Telephone | 701-772-0171
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Fax | 701-772-3138
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KIMBERLY J AMUNDSON
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Credential |
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Telephone | 701-772-0171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 1781
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License Number State | ND
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