Organization
1101 DENTAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER NICHOLE PETRICIG D.D.S. (OWNER/DENTIST)
(701) 795-1101
Entity
Organization
Contact information
Practice address
1101 S COLUMBIA RD, UNIT B, GRAND FORKS, ND 58201-4055
(701) 795-1101
(701) 795-1102
Mailing address
1101 S COLUMBIA RD, UNIT B, GRAND FORKS, ND 58201-4055
(701) 795-1101
(701) 795-1102
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2083
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41566
—
ND
Enumeration date
03/10/2011
Last updated
03/10/2011
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