| Lidgerwood Dental Office | |
|
19 Wiley Ave S Lidgerwood ND 58053-4001 | |
| (701) 538-4583 | |
| (701) 538-4560 |
| Full Name | Lidgerwood Dental Office |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 19 Wiley Ave S, Lidgerwood, North Dakota |
| Authorized Official Name and Position | James D Marotzke (OWNER) |
| Authorized Official Contact | 7015384583 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lidgerwood Dental Office 19 Wiley Ave S Lidgerwood ND 58053-0431 Ph: (701) 538-4583 | Lidgerwood Dental Office 19 Wiley Ave S Lidgerwood ND 58053-4001 Ph: (701) 538-4583 |
| NPI Number | 1285043802 |
|---|---|
| Provider Enumeration Date | 08/07/2014 |
| Last Update Date | 08/07/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285043802 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 1488 (North Dakota) | Primary |
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