| Legendary Smiles | |
|
109 5th St Sw Watford City ND 58854-7135 | |
| (701) 842-4474 | |
| (701) 842-4472 |
| Full Name | Legendary Smiles |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 109 5th St Sw, Watford City, North Dakota |
| Authorized Official Name and Position | Monty Stewart Bulzomi (OWNER/DENTIST) |
| Authorized Official Contact | 7018424474 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Legendary Smiles 109 5th St Sw Po Box 486 Watford City ND 58854-7135 Ph: (701) 842-4474 | Legendary Smiles 109 5th St Sw Watford City ND 58854-7135 Ph: (701) 842-4474 |
| NPI Number | 1023463320 |
|---|---|
| Provider Enumeration Date | 04/25/2016 |
| Last Update Date | 04/25/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023463320 | NPI | - | NPPES |
| 1464401 | Medicaid | ND |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 2238 (North Dakota) | Primary |
Legendary Smiles Dental Group Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 361 N Main St, Watford City, ND 58854 Phone: 701-842-4474 | |
Maisey Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 109 5th St Sw, Box 486, Watford City, ND 58854 Phone: 701-842-4474 |