Individual
GERARD F KOORBUSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MBA
Contact information
Practice address
1140 W CAPITOL AVE, BISMARCK, ND 58501-9956
(701) 258-7220
(701) 222-2329
Mailing address
1140 W CAPITOL AVE, BISMARCK, ND 58501-9956
(701) 258-7220
(701) 222-2329
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
1818
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1818
DENTAL LICENSE
ND
05
—
41121
—
ND
Enumeration date
06/14/2006
Last updated
12/14/2010
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