Healthcare Provider Details

I. General information

NPI: 1578791117
Provider Name (Legal Business Name): TRONSGARD AND SULLIVAN DDS PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 27TH ST S STE C
FARGO ND
58103-8722
US

IV. Provider business mailing address

1231 27TH ST S STE C
FARGO ND
58103-8722
US

V. Phone/Fax

Practice location:
  • Phone: 701-232-6983
  • Fax: 701-239-9375
Mailing address:
  • Phone: 701-232-6983
  • Fax: 701-239-9375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1796
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2056
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMANDA LEIGH BOYER
Title or Position: OFFICE MANAGER
Credential:
Phone: 701-232-6983