Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2007-02-12
- Last updated
- 2025-01-13
Specialties
Licenses
- License ND
- 1016A
Location
- Practice location
- 15 FIRST ST NE
- City
- DUNSEITH ND
- Postal code
- 58329
- Phone
- 701-244-5495
Organization contact
- Name
- JUSTIN DECOTEAU
- Title
- Administrator
- Phone
- 7012445495
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.