1285974048 NPI number — THE DENTAL SUITE P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285974048 NPI number — THE DENTAL SUITE P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE DENTAL SUITE P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285974048
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3255 GREENSBORO DR
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
BISMARCK
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58503-5413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3255 GREENSBORO DR
Provider Second Line Business Practice Location Address:
SUITE 2D
Provider Business Practice Location Address City Name:
BISMARCK
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58503-5413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-255-0469
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/15/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WANGLER
Authorized Official First Name:
ASHLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
701-255-0469

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  2154 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD0000X , with the licence number: 2153 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)