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Organization
LEGENDARY SMILES, P.C.
Active
Organization
LEGENDARY SMILES, P.C.
Active
Other names
Legendary Smiles
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MONTY STEWART BULZOMI D.D.S (OWNER/DENTIST)
(701) 842-4474
Entity
Organization
Contact information
Practice address
109 5TH ST SW, WATFORD CITY, ND 58854-7135
(701) 842-4474
(701) 842-4472
Mailing address
109 5TH ST SW, PO BOX 486, WATFORD CITY, ND 58854-7135
(701) 842-4474
(701) 842-4472
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
2238
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1464401
—
ND
Enumeration date
04/25/2016
Last updated
04/25/2016
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