# BUNTROCK DETNAL PC

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

## Provider details

- **NPI number:** 1558746271
- **Authorized official:** DANELLE ESTRADA (PRACTICE COORDINATOR)
- **Authorized official phone:** (701) 774-3333

## Contact information

- **Practice address:** 2204 2ND AVE W, SUITE 102, WILLISTON, ND 58801-3485
- **Practice address phone:** (701) 774-3333
- **Practice address fax:** (701) 572-1039
- **Mailing address:** 2204 2ND AVE W, SUITE 102, WILLISTON, ND 58801-3485
- **Mailing address phone:** (701) 774-3333
- **Mailing address fax:** (701) 572-1039

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 1726 | MN | — |
| 122300000X | Dentist | 2170 | AZ | Yes |
| 124Q00000X | Dental Hygienist | 1543 | ND | — |

## Other

- **Enumeration date:** 07/23/2015
- **Last updated:** 07/23/2015