Organization
BUNTROCK DETNAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANELLE ESTRADA (PRACTICE COORDINATOR)
(701) 774-3333
Entity
Organization
Contact information
Practice address
2204 2ND AVE W, SUITE 102, WILLISTON, ND 58801-3485
(701) 774-3333
(701) 572-1039
Mailing address
2204 2ND AVE W, SUITE 102, WILLISTON, ND 58801-3485
(701) 774-3333
(701) 572-1039
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
1726
MN
122300000X
Dentist
Primary
2170
AZ
124Q00000X
Dental Hygienist
1543
ND
Other
Enumeration date
07/23/2015
Last updated
07/23/2015
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