1851582100 NPI number — DAKOTA KIDS DENTISTRY

Table of content: DR. MICHAEL CHARLES HARLOW M.D. (NPI 1003007345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851582100 NPI number — DAKOTA KIDS DENTISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAKOTA KIDS DENTISTRY
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:
1851582100
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2615 ELK DR STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINOT
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58701-1200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-839-4440
Provider Business Mailing Address Fax Number:
701-839-1911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2615 ELK DR STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINOT
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58701-1200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-839-4440
Provider Business Practice Location Address Fax Number:
701-839-1911
Provider Enumeration Date:
08/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHAEFER
Authorized Official First Name:
BRIDGET
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
701-839-4440

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  1918 , 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)

  • Identifier: 41292 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




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