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2 1st St W Ste 215 Dickinson ND 58601-5106 | |
| (701) 483-6999 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 2 1st St W Ste 215, Dickinson, North Dakota |
| Authorized Official Name and Position | Brody Peterson (OWNER) |
| Authorized Official Contact | 6056390448 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2 1st St W Ste 215 Dickinson ND 58601-5106 Ph: (701) 483-6999 | 2 1st St W Ste 215 Dickinson ND 58601-5106 Ph: (701) 483-6999 |
| NPI Number | 1902617103 |
|---|---|
| Provider Enumeration Date | 01/16/2025 |
| Last Update Date | 01/16/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902617103 | NPI | - | NPPES |
| 1588313134 | Other | ND | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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