Individual
TERRY LYNN DWELLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD, MPHTM
Contact information
Practice address
805 N 5TH ST, BISMARCK, ND 58501-3908
(701) 258-1804
Mailing address
805 N 5TH ST, BISMARCK, ND 58501-3908
(701) 258-1804
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4112
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4112
NORTH DAKOTA LICENSE
ND
Enumeration date
05/22/2007
Last updated
07/08/2007
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