Organization
DAKOTA DENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CALEB JOHNSEN (DENTIST)
(701) 349-3636
Entity
Organization
Contact information
Practice address
210 MAIN STREET, ELLENDALE, ND 58436
(701) 349-3636
Mailing address
PO BOX 310, ELLENDALE, ND 58436-0310
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
1770
ND
122300000X
Dentist
Primary
2229
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
040501
—
ND
05
—
7850030
—
SD
Enumeration date
06/26/2014
Last updated
12/08/2014
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