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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› Verified 8 days ago
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