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Organization
KENMARE DENTAL CLINIC
Active
Organization
KENMARE DENTAL CLINIC
Active
Parent organization
KENMARE DENTAL CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
KENMARE DENTAL CLINIC
Authorized official
TRACY LYNN THELEN (OFFICE MANAGER)
(701) 385-4041
Entity
Organization
Contact information
Practice address
318 1ST AVE NE, KENMARE, ND 58746-0638
(701) 385-4041
(701) 385-4986
Mailing address
P.O. BOX 638, KENMARE, ND 58746-0638
(701) 385-4041
(701) 385-4986
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1792
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41118
—
ND
Enumeration date
12/02/2008
Last updated
12/02/2008
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