# PRAIRIE ROSE FAMILY DENTISTS

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PRAIRIE ROSE FAMILY DENTISTS
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1679042519
- **Legal business name:** PRAIRIE ROSE FAMILY DENTISTS
- **Authorized official:** DR. RICHARD J HIEB DDS (PARTNER)
- **Authorized official phone:** (701) 223-1194

## Contact information

- **Practice address:** 1110 COLLEGE DR., SUITE 110, BISMARK, ND 58501
- **Practice address phone:** (701) 258-8100
- **Mailing address:** 121 E. FRONT AVE., BISMARK, ND 58504
- **Mailing address phone:** (701) 223-1194
- **Mailing address fax:** (701) 250-9614

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 11/21/2018
- **Last updated:** 11/21/2018