Provider Demographics
NPI:1679326045
Name:SHEYENNE DENTAL, PLLC
Entity type:Organization
Organization Name:SHEYENNE DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEDORA
Authorized Official - Middle Name:CAROLINE
Authorized Official - Last Name:WEST-ROEHL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:701-850-8712
Mailing Address - Street 1:3285 FIECHTNER DR S STE C
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2490
Mailing Address - Country:US
Mailing Address - Phone:701-850-8712
Mailing Address - Fax:
Practice Address - Street 1:3285 FIECHTNER DR S STE C
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2490
Practice Address - Country:US
Practice Address - Phone:701-850-8712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental