# KENMARE DENTAL CLINIC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** KENMARE DENTAL CLINIC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1164677399
- **Legal business name:** KENMARE DENTAL CLINIC
- **Authorized official:** TRACY LYNN THELEN (OFFICE MANAGER)
- **Authorized official phone:** (701) 385-4041

## Contact information

- **Practice address:** 318 1ST AVE NE, KENMARE, ND 58746-0638
- **Practice address phone:** (701) 385-4041
- **Practice address fax:** (701) 385-4986
- **Mailing address:** P.O. BOX 638, KENMARE, ND 58746-0638
- **Mailing address phone:** (701) 385-4041
- **Mailing address fax:** (701) 385-4986

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 1792 | ND | Yes |

## Other

- **Enumeration date:** 12/02/2008
- **Last updated:** 12/02/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 41118 | — | ND |