MEDICARE: MIDSTOKKE FAMILY DENTISTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	1992	ND

General Provider Information

NPI Number	:	1558657437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDSTOKKE FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	2940 N 19TH ST
Second Line	:	SUITE2
City	:	BISMARCK
State	:	ND
Zip	:	58503-5393
Country	:	US
Telephone Number	:	701-255-0475
Fax Number	:	701-258-4096

Provider Business Practice Location Address
First Line	:	2940 N 19TH ST
Second Line	:	SUITE2
City	:	BISMARCK
State	:	ND
Zip	:	58503-5393
Country	:	US
Telephone Number	:	701-255-0475
Fax Number	:	701-258-4096

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEVE J. MIDSTOKKE
Credential	:	DDS
Telephone Number	:	701-255-0475

Provider Enumeration Date	:	06/20/2011
Last Update Date	:	06/20/2011

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