| Organization Name: | CONCEPT DENTISTRY PC |
| NPI Number: | 1184061012 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRIAN E BULIK (OWNER) |
| Mailing Address: | 117 3rd St Nw Valley City |
| State: | ND US |
| Postal Code: | 580722900 |
| Phone Number: | 7018453708 |
| Fax Number: | 7018450362 |
| NPI Enumeration Date: | 06/01/2013 |
| NPI Last Update Date: | 06/01/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 2079 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ND |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |