Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | ND1603 | ND |
NPI | 1003960410 |
---|---|
Provider Name | Dr. Kevin S. Bjork |
First Address | Bismarck, ND 58501-1616 |
Second Address | Bismarck, ND 58501-1616 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 08/07/2007 |