Healthcare Provider Details

I. General information

NPI: 1427226125
Provider Name (Legal Business Name): NORTHERN FACIAL SURGEONS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2331 TYLER PKWY SUITE 4
BISMARCK ND
58503-0871
US

IV. Provider business mailing address

2331 TYLER PKWY SUITE 4
BISMARCK ND
58503-0871
US

V. Phone/Fax

Practice location:
  • Phone: 701-255-4000
  • Fax: 701-255-1992
Mailing address:
  • Phone: 701-255-4000
  • Fax: 701-255-1992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateND

VIII. Authorized Official

Name: MRS. CHARLENE ANN SCHMALTZ
Title or Position: PRACTICE COORDINATOR
Credential:
Phone: 701-255-4000