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General NPI Number Information
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NPI Number | 1558034777
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Entity Type | Organization
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Legal Business Name | BISMARCK DENTISTRY PC
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Dates
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Enumeration Date | 07/26/2021
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Last Update Date | 07/26/2021
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Provider Practice Location Address
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Address Line | 620 19TH ST W STE 200
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City | DICKINSON
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State | ND
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Zip | 58601-2972
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Country | US
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Telephone | 701-502-0060
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Fax |
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Provider Business Mailing Address
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Address Line | 4401 COLEMAN ST STE 104
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City | BISMARCK
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State | ND
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Zip | 58503-1371
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Country | US
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Telephone | 701-751-8081
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Fax | 701-751-0836
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANIEL BRIAN VAN BUSKIRK
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Credential | D.D.S.
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Telephone | 701-751-8081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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