Dental Directory NORTH DAKOTA

Dental Directory NORTH DAKOTA

Table of Contents CONNECTION DENTAL NETWORK Burke County...3 Burleigh County...3 Cass County...3 Grand Forks County...4 McLean County...4 Pembina County...5 Richland County...5 Rolette County...5 Sheridan County...6 Walsh County...6 Ward County...6 Williams County...7 NOMINATION FORM...10 Please note: All providers listed are directly contracted with the Connection Dental Network but not at all locations in which they practice. Before receiving services, it is the member's responsibility to verify that the provider is considered a Connection Dental provider at the location services are rendered (or performed). 1 Updated August 7, 2018

Please note: All providers listed are directly contracted with the Connection Dental Network but not at all locations in which they practice. Before receiving services, it is the member s responsibility to verify that the provider is considered a Connection Dental provider at the location services are rendered (or performed). Connection Dental is an Open Panel Dental PPO Network. Dentists are welcome to join the network if they meet our credentialing criteria, agree to participation terms and are approved.

Burke County North Dakota Participating Dentists Cass County Burke County 18 Main St SW Bowbells, ND 58721 (701) 377-6400 Burleigh County 914 S 12th St Ste 101 Bismarck, ND 58504 (701) 255-4242 Martinson, James W University of Minnesota-School of Dentis, 1991 1001 W Interstate Ave Ste 132 Bismarck, ND 58503 (701) 223-1476 Mon: 8-6 Tues: 8-5 Fri: 8-12 Midstokke, Steven J 2006 2940 N 19th St Ste 2 Bismarck, ND 58503 (701) 255-0475 Wangler, Ashley D University Of Minnesota, 2016 3255 Greensboro Dr Ste 101 Bismarck, ND 58503 (701) 255-0469 Fri: 8-12 Wangler, Nicholas P University Of Minnesota-School Of Dentis, Hennepin County Med Center, 2008 3255 Greensboro Dr Ste 101 Bismarck, ND 58503 (701) 255-0469 Fri: 8-12 Cass County Oral Maxillofacial Surgery Noffze, Michael J Indiana University School of Dentistry, Mayo Clinic College of Medicine - Roches, 1996, Essentia Health Hospital 300 Main Ave Ste 201 Fargo, ND 58103 (701) 232-9565 omsassociatesltd@hotmail.com Day, Joshua B University of Minnesota-School of Dentis, 2010 4302 13th Ave S Ste 10 Fargo, ND 58103 (701) 281-8000 Mon: 8-5 Tues: 10-7 Sat: 8-4 Eaton, Matthew J University of Minnesota-School of Dentis, 2010 1338 Gateway Dr S Ste 4 Fargo, ND 58103 (701) 232-1664 Please note: All providers listed are directly contracted with the Connection Dental Network but not at all locations in which they practice. Before receiving services, it is the member's responsibility to verify that the provider is considered a Connection Dental provider at the location services are rendered (or performed). Handicap Accessible Updated August 7, 2018 3

Cass County North Dakota Participating Dentists McLean County Quamme, Brian J University of Minnesota, 1978 4302 13th Ave S Ste 10 Fargo, ND 58103 (701) 281-8000 Mon: 8-5 Tues: 10-7 Sat: 8-4 Rai, Danny M University of Minnesota, 2016 4302 13th Ave S Ste 10 Fargo, ND 58103 (701) 281-8000 Mon: 8-5 Tues: 10-7 Sat: 8-4 Languages spoken: Arabic, German Sampson, Svetlana K 2011 4575 23rd Ave S Ste 1200 Fargo, ND 58104 (701) 356-4077 office@aboutsmilesdentalfm.com Mon: 9-7 Tues: 9-7 Wed: 9-6 Sat: 9-5 Languages spoken: Russian Smith, Meghan M University of Minnesota-School of Dentis, 2010 1338 Gateway Dr S Ste 4 Fargo, ND 58103 (701) 232-1664 Grand Forks County Austriaco, Jerome B Aspen Dental Management Inc 3300 32nd Ave S Ste 101 Grand Forks, ND 58201 (701) 765-3494 Mon: 9-6 Tues: 11-8 Wed: 9-6 Thurs: 9-6 Beltran, Katalina Temple University, 2017 Aspen Dental Management Inc 3300 32nd Ave S Ste 103 Grand Forks, ND 58201 (701) 765-3494 Mon: 730-530 Tues: 730-530 Wed: 730-530 Thurs: 10-8 Fri: 8-1 Manke, Lauren R 2013 1321 S Washington St Grand Forks, ND 58201 (701) 772-6901 info@mankedental.com Manke, Rory B 2013 1321 S Washington St Grand Forks, ND 58201 (701) 772-6901 Mon: 8-430 Tues: 8-430 Wed: 8-430 Thurs: 8-430 Fri: 8-430 2401 S Washington St Ste B Grand Forks, ND 58201 (701) 772-8158 Mon: 8-430 Tues: 8-430 Wed: 8-430 Thurs: 8-430 Schefter, Daniel J 1985 3001 32nd Ave S Ste B Grand Forks, ND 58201 (701) 775-7005 McLean County Endodontics Zerr, Marvin A Univ of Nebraska College of Dentistry, Univ of Iowa College of Dentistry, 1989 104 Main St (701) 448-9244 Handicap Accessible Updated August 7, 2018 4 Some providers may not participate in our network at all locations in which they practice. Before receiving services, it is the member's responsibility to verify that the provider is a participating provider at the location the member receives services. This list is subject to change.

McLean County North Dakota Participating Dentists Rolette County Bruins, Whitney V 416 Kundert St (701) 448-9111 Sat: 9-3 Burbach, Nathan J 2014 416 Kundert St (701) 448-9111 Faure, Nicholas B Oregon Health & Science University, 2016 416 Kundert St (701) 448-9225 Greer, Murray E 1986 416 Kundert St (701) 448-9225 416 Kundert St (701) 448-9225 Zerr, Marvin A Univ of Nebraska College of Dentistry, Univ of Iowa College of Dentistry, 1989 416 Kundert St (704) 448-9225 Pembina County Schefter, Daniel J 1985 301 5th St Walhalla, ND 58282 (701) 549-3580 Richland County Devsi, Manmohan S 1991 324 Dakota Ave Wahpeton, ND 58075 (701) 642-2644 Rolette County Endodontics Zerr, Marvin A Univ of Nebraska College of Dentistry, Univ of Iowa College of Dentistry, 1989 401 2nd Ave Rolette, ND 58366 (701) 246-3391 Burbach, Nathan J 2014 401 2nd Ave Rolette, ND 58366 (701) 246-3391 Faure, Nicholas B Oregon Health & Science University, 2016 401 2nd Ave Rolette, ND 58366 (701) 246-3391 Greer, Murray E 1986 401 2nd Ave Rolette, ND 58366 (701) 246-3391 Mon: 8-630 Tues: 8-5 Some providers may not participate in our network at all locations in which they practice. Before receiving services, it is the member's responsibility to verify that the provider is a participating provider at the location the member receives services. This list is subject to change. Handicap Accessible Updated August 7, 2018 5

Rolette County North Dakota Participating Dentists Ward County 114 3rd St NE Rolla, ND 58367 (701) 477-3111 401 2nd Ave Rolette, ND 58366 (701) 246-3391 Sheridan County 122 E 2nd St Mcclusky, ND 58463 (701) 363-2296 Walsh County Beneda, Nicholas D 2007 202 Park St E Park River, ND 58270 (701) 284-6131 Brewer, Boone T University of Minnesota-School of Dentis, 2007 17 E 7th St Grafton, ND 58237 (701) 352-2450 Languages spoken: Korean, Spanish Larson, Brian J University of Minnesota-School of Dentis, 1990 202 Park St E Park River, ND 58270 (701) 284-6131 Ward County Bruins, Whitney V 15 2nd Ave SW Ste 110 (701) 838-3051 Burbach, Nathan J 2014 15 2nd Ave SW Ste 110 (701) 838-3051 Faure, Nicholas B Oregon Health & Science University, 2016 15 2nd Ave SW Ste 110 (701) 838-3051 asmith@northlandchc.org Greer, Murray E 1986 15 2nd Ave SW Ste 110 (701) 838-3051 15 2nd Ave SW Ste 110 (701) 838-3051 1600 2nd Ave SW Ste 19 (701) 852-4600 Handicap Accessible Updated August 7, 2018 6 Some providers may not participate in our network at all locations in which they practice. Before receiving services, it is the member's responsibility to verify that the provider is a participating provider at the location the member receives services. This list is subject to change.

Ward County North Dakota Participating Dentists Williams County Zerr, Marvin A Univ of Nebraska College of Dentistry, Univ of Iowa College of Dentistry, 1989 15 2nd Ave SW Ste 110 (701) 838-3051 Williams County Faure, Nicholas B Oregon Health & Science University, 2016 24 Railroad Ave Ste 16 Ray, ND 58849 (701) 568-5600 24 Railroad Ave Ste 16 Ray, ND 58849 (701) 568-5600 Some providers may not participate in our network at all locations in which they practice. Before receiving services, it is the member's responsibility to verify that the provider is a participating provider at the location the member receives services. This list is subject to change. Handicap Accessible Updated August 7, 2018 7

Alphabetical Index of Participating Dentists A Austriaco, Jerome B... 4 B Beltran, Katalina... 4 Beneda, Nicholas D... 6 Brewer, Boone T... 6 Bruins, Whitney V... 5, 6 Burbach, Nathan J... 5, 6 D Day, Joshua B... 3 Devsi, Manmohan S... 5 E Eaton, Matthew J... 3 F Faure, Nicholas B... 5, 6, 7 M Manke, Lauren R... 4 Manke, Rory B... 4 Martinson, James W... 3 Midstokke, Steven J... 3 N Noffze, Michael J... 3 Q Quamme, Brian J... 4 R Rai, Danny M... 4 S Sampson, Svetlana K... 4 Schefter, Daniel J... 4, 5 Smith, Meghan M... 4 G Greer, Murray E... 5, 6 K... 3, 5, 6, 7 W Wangler, Ashley D... 3 Wangler, Nicholas P... 3 Z Zerr, Marvin A... 4, 5, 7 L Larson, Brian J... 6 9

Dentist Nomination Form If the dentist of your choice is not listed in this directory, you may complete this form to nominate the dentist to participate in the Connection Dental Network. An Application packet will be sent to the eligible providers. The normal time frame for credentialing of dentists takes approximately 90 days after application has been received. Dentist Information Name: Address: Phone: Fax: Member Information Name: Address: Phone: Fax: Member Identification Number: Employer Group Name: Group Number: Please Mail the form to the following address: PPO USA, Inc. P.O. Box 7010 Lee s Summit, MO 64086 7010 Attn: Operations Fax to Operations at 816 257 4436 Call 877 277 6872 Email cs.ppousa@geha.com Thank you for your interest in the Connection Dental Network.