South University Dental Associates, PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

1493 Issued in ND

Legal business name

SOUTH UNIVERSITY DENTAL ASSOCIATES, PC

Practice address

3115 University Dr S
Fargo, ND 58103-6049

Phone

(701) 232-8884

Fax

(701) 232-6064

NPI assigned

Dec 29, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Thomas Glen Fellman, DDS

Title

President

Phone

(701) 232-8884

Specialties & licenses 3

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1293580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1293580800000",
    "number": "1043514367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3115 UNIVERSITY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581036049",
            "telephone_number": "701-232-8884",
            "fax_number": "701-232-6064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3115 UNIVERSITY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581036049",
            "telephone_number": "701-232-8884",
            "fax_number": "701-232-6064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH UNIVERSITY DENTAL ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-29",
        "last_updated": "2010-12-29",
        "status": "A",
        "authorized_official_last_name": "FELLMAN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "GLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "701-232-8884",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "ND",
            "license": "1493",
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "ND",
            "license": "1843",
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "ND",
            "license": "2068",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Fargo, ND
• Providers in Fargo, ND by specialty
• Dental Clinic/Center in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.