Organization
DAKOTA DENTAL
Active
Other names
Pheasant Run Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN BLACKHURST D.O. (DENTIST)
(701) 577-3333
Entity
Organization
Contact information
Practice address
2605 19TH AVE W, SUITE 102, WILLISTON, ND 58801-2892
(701) 577-3333
(701) 577-3336
Mailing address
2605 19TH AVE W, SUITE 102, WILLISTON, ND 58801-2892
(701) 577-3333
(701) 577-3336
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
2208
NC
261QD0000X
Dental Clinic/Center
2209
ND
261QD0000X
Dental Clinic/Center
Primary
2210
ND
Other
Enumeration date
09/18/2014
Last updated
06/20/2018
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