Advanced Dental Technologies Center
Organization Active NPI Dentist · Fargo, ND
NPI 1114308285 · NPPES record last updated Jun 15, 2015
Key facts
- NPI
- 1114308285
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dentist 122300000X
- License
- 1617 (ND)
- Legal business name
- ADVANCED DENTAL TECHNOLOGIES CENTER
- Practice address
- 827 28TH St S Ste a
Fargo, ND 58103-8727 - Phone
- (701) 280-1020
- Fax
- (701) 280-1460
- NPI assigned
- Jun 15, 2015
- Organization subpart
- No
Authorized official
- Name
- Dr. David Gordon Brant, DR.
- Title
- Dentist
- Phone
- (701) 280-1020
National Provider Directory
Locations
827 28th St S
Ste A
Fargo, ND 58103
Phone (701) 280-1020
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist |
122300000X | 1617 | ND | Yes |
Addresses
Primary practice location
827 28TH St S Ste a
Fargo, ND 58103-8727
Mailing address
827 28TH St S Ste a
Fargo, ND 58103-8727
Phone (701) 280-1020
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40002 | Medicaid | ND |
Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 15, 2015. 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.