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NPI Code Detail

MEDICARE: DR. BRADLEY MARK KASSON DDS

MEDICARE: DR. BRADLEY MARK KASSON DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry1463ND

General Provider Information

NPI Number : 1346212479
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRADLEY MARK KASSON DDS
Provider Business Mailing Address
First Line : 3136 9 1/2 ST N
Second Line :
City : FARGO
State : ND
Zip : 58102-1300
Country : US
Telephone Number : 701-232-2101
Fax Number :
Provider Business Practice Location Address
First Line : 2101 ELM ST N
Second Line :
City : FARGO
State : ND
Zip : 58102-2417
Country : US
Telephone Number : 701-239-3700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2006
Last Update Date : 07/08/2007

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Directions to “ DR. BRADLEY MARK KASSON DDS” Practice Location

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