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Organization
IMPLANT&MAXILLOFACIAL SURGICAL CENTER
Active
Organization
IMPLANT&MAXILLOFACIAL SURGICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUAN J. ULLOA DDS (ORAL&MAXILLOFACIAL SURGEON/OWNER)
(701) 721-5254
Entity
Organization
Contact information
Practice address
2224 1ST AVE W STE 2, WILLISTON, ND 58801-6286
(701) 721-5254
Mailing address
2224 1ST AVE W STE 2, WILLISTON, ND 58801-6286
(701) 721-5254
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
1993
ND
Other
Enumeration date
04/02/2014
Last updated
04/02/2014
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