Provider Demographics
NPI:1285974048
Name:THE DENTAL SUITE P.C.
Entity type:Organization
Organization Name:THE DENTAL SUITE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WANGLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-255-0469
Mailing Address - Street 1:3255 GREENSBORO DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-5413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3255 GREENSBORO DR
Practice Address - Street 2:SUITE 2D
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-5413
Practice Address - Country:US
Practice Address - Phone:701-255-0469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-15
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2153261QD0000X
ND2154261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental