Healthcare Provider Details

I. General information

NPI: 1538147848
Provider Name (Legal Business Name): MICHAEL J NOFFZE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 05/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2856 BRANDT DR S
FARGO ND
58104-8805
US

IV. Provider business mailing address

2856 BRANDT DR S
FARGO ND
58104-8805
US

V. Phone/Fax

Practice location:
  • Phone: 701-232-9565
  • Fax: 701-298-0853
Mailing address:
  • Phone: 701-232-9565
  • Fax: 701-298-0853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number11700
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number49823
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2025
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: