Healthcare Provider Details

I. General information

NPI: 1669558672
Provider Name (Legal Business Name): MELINDA HARR, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 32ND AVE S
FARGO ND
58103-5905
US

IV. Provider business mailing address

1509 32ND AVE S
FARGO ND
58103-5905
US

V. Phone/Fax

Practice location:
  • Phone: 701-271-1060
  • Fax: 701-271-1164
Mailing address:
  • Phone: 701-271-1060
  • Fax: 701-271-1164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1905
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MELINDA A HARR
Title or Position: PRESIDENT
Credential: DDS
Phone: 701-271-1060