Provider Demographics
NPI:1285450544
Name:BISMARCK STATE COLLEGE
Entity type:Organization
Organization Name:BISMARCK STATE COLLEGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAINOA
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:701-224-2644
Mailing Address - Street 1:210 W CENTURY AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-1494
Mailing Address - Country:US
Mailing Address - Phone:701-224-2644
Mailing Address - Fax:
Practice Address - Street 1:210 W CENTURY AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-1494
Practice Address - Country:US
Practice Address - Phone:701-224-2644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty