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Individual

DR. PAUL THOMAS BOTHUN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
DAKOTA DENTAL ASSOCIATES PC, 4000 17TH AVE S, GRAND FORKS, ND 58201-3905
(701) 775-0641
(701) 746-9328
Mailing address
DAKOTA DENTAL ASSOCIATES PC, 4000 17TH AVE S, GRAND FORKS, ND 58201-3905
(701) 775-0641
(701) 746-9328

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1791
ND

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
788399
UNITED CONCORDIA
01
901791
DENTAL SERVICES CORP
ND
Enumeration date
08/30/2006
Last updated
05/08/2021
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