| 1101 Dental, Pllc | |
|
1101 S Columbia Rd Unit B Grand Forks ND 58201-4055 | |
| (701) 795-1101 | |
| (701) 795-1102 |
| Full Name | 1101 Dental, Pllc |
|---|---|
| Speciality | Dentist |
| Location | 1101 S Columbia Rd, Grand Forks, North Dakota |
| Authorized Official Name and Position | Heather Nichole Petricig (OWNER/DENTIST) |
| Authorized Official Contact | 7017951101 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 1101 Dental, Pllc 1101 S Columbia Rd Unit B Grand Forks ND 58201-4055 Ph: (701) 795-1101 | 1101 Dental, Pllc 1101 S Columbia Rd Unit B Grand Forks ND 58201-4055 Ph: (701) 795-1101 |
| NPI Number | 1750689030 |
|---|---|
| Provider Enumeration Date | 03/10/2011 |
| Last Update Date | 03/10/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750689030 | NPI | - | NPPES |
| 41566 | Medicaid | ND |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 2083 (North Dakota) | Primary |
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