MEDICARE: DR. WHITNEY VIOLET BRUINS D.D.S.

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	1223G0001X	General Practice Dentistry	2251	ND

General Provider Information

NPI Number	:	1568843878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WHITNEY VIOLET BRUINS D.D.S.

Provider Business Mailing Address
First Line	:	1131 KELLY DR
Second Line	:
City	:	WASHBURN
State	:	ND
Zip	:	58577-4111
Country	:	US
Telephone Number	:	701-320-4259
Fax Number	:

Provider Business Practice Location Address
First Line	:	416 KUNDERT ST
Second Line	:
City	:	TURTLE LAKE
State	:	ND
Zip	:	58575-4205
Country	:	US
Telephone Number	:	701-448-9111
Fax Number	:	701-448-9224

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2015
Last Update Date	:	06/11/2015

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