Daniel Lawrence Mengedoth, DDS
Individual provider Active NPI General Practice Dentistry · Fargo, ND
NPI 1033540539 · NPPES record last updated Dec 9, 2013
Key facts
- NPI
- 1033540539
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 2087 (ND)
- Practice address
- 2585 23Rd Ave S
Suite C
Fargo, ND 58103-6172 - Phone
- (701) 356-1280
- Fax
- (701) 356-1281
- NPI assigned
- Dec 9, 2013
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2087 | ND | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2087 | ND | Yes |
Addresses
Primary practice location
2585 23Rd Ave S
Suite C
Fargo, ND 58103-6172
Mailing address
2585 23Rd Ave
Suite C
Fargo, ND 58103
Phone (701) 356-1280
Other providers in Fargo, ND
- Paul R Melicher
- Melinda Harr, DDS, PC
- Gary Douglas Mellum
- Stephanie Janine Melquist
- Dyan P Melton
- Laura Mennenga
- Dennis Nana Asah Mensah
- Teta Elaine Mensah
- Janelle Mercado
- Mai Mardea Merchant
All providers in Fargo, ND · General Practice Dentistry 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 Dec 9, 2013. 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.