Terry Lynn Dwelle, MD, MPHTM – Pediatrics Physician

Key facts

NPI: 1104035252
Entity type: Individual (NPI type 1)
Primary specialty: Pediatrics Physician 208000000X
License: 4112 (ND)
Practice address: 805 N 5TH St
Bismarck, ND 58501-3908
Phone: (701) 258-1804
NPI assigned: May 22, 2007
Sex: Male
Sole proprietor: Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Spirit Lake Tribe Case Management Agency · Fort Totten, ND · NPI 1720152457

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
4112	ND	MD	Mental Health Counselor

Practice roles

Organization	Specialty	Status	New patients
Spirit Lake Tribe		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pediatrics Physician	208000000X	4112	ND	Yes

Addresses

Primary practice location

805 N 5TH St
Bismarck, ND 58501-3908

Mailing address

805 N 5TH St
Bismarck, ND 58501-3908
Phone (701) 258-1804

Other identifiers

Identifier	Type	State	Issuer
4112	Other	ND	NORTH DAKOTA LICENSE

Other providers in Bismarck, ND

All providers in Bismarck, ND · Pediatrics Physician in North Dakota

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.