Provider Demographics
NPI:1972723609
Name:MARK E. JAHRAUS, DDS, PC
Entity type:Organization
Organization Name:MARK E. JAHRAUS, DDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORP. PRES.
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:JAHRAUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-748-2730
Mailing Address - Street 1:PO BOX 642
Mailing Address - Street 2:
Mailing Address - City:HAZEN
Mailing Address - State:ND
Mailing Address - Zip Code:58545-0642
Mailing Address - Country:US
Mailing Address - Phone:701-748-2730
Mailing Address - Fax:
Practice Address - Street 1:204 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:HAZEN
Practice Address - State:ND
Practice Address - Zip Code:58545-0642
Practice Address - Country:US
Practice Address - Phone:701-748-2730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND17311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty