Healthcare Provider Details

I. General information

NPI: 1033617238
Provider Name (Legal Business Name): SAVING SMILES DENISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 18TH ST S STE B
FARGO ND
58104-6789
US

IV. Provider business mailing address

3210 18TH ST S STE B
FARGO ND
58104-6789
US

V. Phone/Fax

Practice location:
  • Phone: 701-237-4297
  • Fax: 701-237-2223
Mailing address:
  • Phone: 701-237-4297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2022
License Number StateND

VIII. Authorized Official

Name: JANE M WOLFF
Title or Position: OFFICE MANAGER
Credential:
Phone: 701-237-4297