# IMPLANT&MAXILLOFACIAL SURGICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255759650
- **Authorized official:** DR. JUAN J. ULLOA DDS (ORAL&MAXILLOFACIAL SURGEON/OWNER)
- **Authorized official phone:** (701) 721-5254

## Contact information

- **Practice address:** 2224 1ST AVE W STE 2, WILLISTON, ND 58801-6286
- **Practice address phone:** (701) 721-5254
- **Mailing address:** 2224 1ST AVE W STE 2, WILLISTON, ND 58801-6286
- **Mailing address phone:** (701) 721-5254

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 1993 | ND | Yes |

## Other

- **Enumeration date:** 04/02/2014
- **Last updated:** 04/02/2014