Healthcare Provider Details

I. General information

NPI: 1427976802
Provider Name (Legal Business Name): CASEY SABO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 4TH AVE N
MOORHEAD MN
56560-2473
US

IV. Provider business mailing address

701 10TH ST S
FARGO ND
58103-2605
US

V. Phone/Fax

Practice location:
  • Phone: 218-236-6502
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH10136
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: