Healthcare Provider Details

I. General information

NPI: 1407341217
Provider Name (Legal Business Name): HEALING WITH HYPERBARICS OF NORTH DAKOTA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4487 CALICO DR S UNIT B
FARGO ND
58104
US

IV. Provider business mailing address

4487 CALICO DR S UNIT B
FARGO ND
58104-9040
US

V. Phone/Fax

Practice location:
  • Phone: 701-532-2426
  • Fax: 701-532-1746
Mailing address:
  • Phone: 701-532-2426
  • Fax: 701-936-6217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberPT15122
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAPHNE WATKINS DENHAM
Title or Position: OWNER
Credential: MD
Phone: 701-532-2426