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Organization
SOURIS VALLEY DENTAL GROUP
Active
Organization
SOURIS VALLEY DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK A HILDAHL DDS (OWNER)
(701) 852-5595
Entity
Organization
Contact information
Practice address
1300 37TH AVE SW, MINOT, ND 58701-7240
(701) 852-5595
(701) 852-2669
Mailing address
1300 37TH AVE SW, MINOT, ND 58701-7240
(701) 852-5595
(701) 852-2669
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1573
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000980706
UNITED CONCORDIA
ND
05
—
41311
—
ND
Enumeration date
06/20/2005
Last updated
06/12/2015
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