# DAKOTA DENTAL ASSOCIATES PC

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

## Provider details

- **NPI number:** 1417067919
- **Authorized official:** DR. PAUL THOMAS BOTHUN DDS (PRESIDENT - OWNER)
- **Authorized official phone:** (701) 775-0641

## Contact information

- **Practice address:** 4000 17TH AVE S, GRAND FORKS, ND 58201-3905
- **Practice address phone:** (701) 775-0641
- **Practice address fax:** (701) 746-9328
- **Mailing address:** 4000 17TH AVE S, GRAND FORKS, ND 58201-3905
- **Mailing address phone:** (701) 775-0641
- **Mailing address fax:** (701) 746-9328

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 08/30/2006
- **Last updated:** 05/23/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 788399 | UNITED CONCORDIA | — |