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Individual

DR. ROGER MARTIN AMUNDSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DDS, FAGD

Contact information

Practice address
2600 DEMERS AVE, GRAND FORKS, ND 58201-4100
(701) 772-0171
Mailing address
2600 DEMERS AVE, GRAND FORKS, ND 58201-4100
(701) 772-0171

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1781
ND

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
41067
ND
01
901781
DSC CORPORATION
ND
Enumeration date
11/07/2006
Last updated
07/13/2021
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