Healthcare Provider Details

I. General information

NPI: 1144899030
Provider Name (Legal Business Name): AFFORDABLE DENTURES & IMPLANTS - NORTH DAKOTA II, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 13TH AVE S STE 10
FARGO ND
58103-3395
US

IV. Provider business mailing address

4302 13TH AVE S STE 10
FARGO ND
58103-3395
US

V. Phone/Fax

Practice location:
  • Phone: 701-281-8000
  • Fax:
Mailing address:
  • Phone: 701-281-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DEREK WEIGAND
Title or Position: OWNER
Credential: DMD
Phone: 701-281-8000