| Dakota Dental Care | |
|
210 Main Street Ellendale ND 58436 | |
| (701) 349-3636 | |
| Not Available |
| Full Name | Dakota Dental Care |
|---|---|
| Speciality | Dentist |
| Location | 210 Main Street, Ellendale, North Dakota |
| Authorized Official Name and Position | Caleb Johnsen (DENTIST) |
| Authorized Official Contact | 7013493636 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dakota Dental Care Po Box 310 Ellendale ND 58436-0310 Ph: () - | Dakota Dental Care 210 Main Street Ellendale ND 58436 Ph: (701) 349-3636 |
| NPI Number | 1225443310 |
|---|---|
| Provider Enumeration Date | 06/26/2014 |
| Last Update Date | 12/08/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225443310 | NPI | - | NPPES |
| 040501 | Medicaid | ND | |
| 7850030 | Medicaid | SD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 1770 (North Dakota) | Secondary |
| 122300000X | Dentist | 2229 (North Dakota) | Primary |
Dakota Dental Care Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 210 Main St, Ellendale, ND 58436 Phone: 701-349-3636 Fax: 701-349-2137 |