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Oral Surgery, Dental Specialists

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Fargo, North Dakota

Provider NPI: 1649331562

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
Tel: 701-235-3205  Fax: 701-235-3205

Business Mailing Address:
Tel: 701-235-3205  Fax: 701-235-3205

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y122300000XDental Providers

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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