Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223X0400X | Orthodontists | 11516 | MN |
Y | 1223X0400X | Orthodontists | 1979 | ND |
NPI | 1053385468 |
---|---|
Provider Name | Dr. Bryan M Vibeto |
First Address | Minot, ND 58701-1200 |
Second Address | Minot, ND 58701-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 16/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
41460 | (05) | ND |
V04913 | (02) |