Organization
DAKOTA DENTAL ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL THOMAS BOTHUN DDS (PRESIDENT - OWNER)
(701) 775-0641
Entity
Organization
Contact information
Practice address
4000 17TH AVE S, GRAND FORKS, ND 58201-3905
(701) 775-0641
(701) 746-9328
Mailing address
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
788399
UNITED CONCORDIA
—
Enumeration date
08/30/2006
Last updated
05/23/2016
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