Healthcare Provider Details

I. General information

NPI: 1780761031
Provider Name (Legal Business Name): SCOTT A PREISLER DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4344 20TH AVE S SUITE 2
FARGO ND
58103-7436
US

IV. Provider business mailing address

4344 20TH AVE S SUITE 2
FARGO ND
58103-7436
US

V. Phone/Fax

Practice location:
  • Phone: 701-239-5969
  • Fax: 701-239-0034
Mailing address:
  • Phone: 701-239-5969
  • Fax: 701-239-0034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1833
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: