| Dakota Dental Associates Pc | |
|
4000 17th Ave S Grand Forks ND 58201-3905 | |
| (701) 775-0641 | |
| (701) 746-9328 |
| Full Name | Dakota Dental Associates Pc |
|---|---|
| Speciality | Dentist |
| Location | 4000 17th Ave S, Grand Forks, North Dakota |
| Authorized Official Name and Position | Paul Thomas Bothun (PRESIDENT - OWNER) |
| Authorized Official Contact | 7017750641 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dakota Dental Associates Pc 4000 17th Ave S Grand Forks ND 58201-3905 Ph: (701) 775-0641 | Dakota Dental Associates Pc 4000 17th Ave S Grand Forks ND 58201-3905 Ph: (701) 775-0641 |
| NPI Number | 1417067919 |
|---|---|
| Provider Enumeration Date | 08/30/2006 |
| Last Update Date | 05/23/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417067919 | NPI | - | NPPES |
| 788399 | Other | UNITED CONCORDIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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