Provider Demographics
NPI:1053385468
Name:VIBETO, BRYAN M (DDS)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:M
Last Name:VIBETO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 ELK DR STE 2
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-1200
Mailing Address - Country:US
Mailing Address - Phone:701-839-6010
Mailing Address - Fax:
Practice Address - Street 1:2615 ELK DR
Practice Address - Street 2:STE 2
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-0001
Practice Address - Country:US
Practice Address - Phone:701-839-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115161223X0400X
ND19791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND41460Medicaid
V04913Medicare UPIN