NPI 1417067919 · live from the CMS NPI Registry
Dakota Dental Associates PC
Dentist in Grand Forks, ND. National Provider Identifier 1417067919, active.
NPI record
| NPI | 1417067919 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dentist 122300000X |
| Practice location | 4000 17th Ave S, Grand Forks, ND 58201 |
| Practice phone | 701-775-0641 |
| Enumerated | August 30, 2006 |
| Last updated | May 23, 2016 |
| Authorized official | Paul Bothun, President - Owner |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist primary | 122300000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.