# 1101 DENTAL, PLLC

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

## Provider details

- **NPI number:** 1750689030
- **Authorized official:** HEATHER NICHOLE PETRICIG D.D.S. (OWNER/DENTIST)
- **Authorized official phone:** (701) 795-1101

## Contact information

- **Practice address:** 1101 S COLUMBIA RD, UNIT B, GRAND FORKS, ND 58201-4055
- **Practice address phone:** (701) 795-1101
- **Practice address fax:** (701) 795-1102
- **Mailing address:** 1101 S COLUMBIA RD, UNIT B, GRAND FORKS, ND 58201-4055
- **Mailing address phone:** (701) 795-1101
- **Mailing address fax:** (701) 795-1102

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 2083 | ND | Yes |

## Other

- **Enumeration date:** 03/10/2011
- **Last updated:** 03/10/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 41566 | — | ND |