Provider Demographics
NPI:1154579274
Name:PARSHALL DENTAL CLINIC
Entity type:Organization
Organization Name:PARSHALL DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTVOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-862-3121
Mailing Address - Street 1:20 S MAIN
Mailing Address - Street 2:PO BOX 520
Mailing Address - City:PARSHALL
Mailing Address - State:ND
Mailing Address - Zip Code:58770-0520
Mailing Address - Country:US
Mailing Address - Phone:701-862-3121
Mailing Address - Fax:
Practice Address - Street 1:20 S MAIN
Practice Address - Street 2:
Practice Address - City:PARSHALL
Practice Address - State:ND
Practice Address - Zip Code:58770-0520
Practice Address - Country:US
Practice Address - Phone:701-862-3121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND41163Medicaid