Healthcare Provider Details

I. General information

NPI: 1144450610
Provider Name (Legal Business Name): KANGAS HARDY DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2009
Last Update Date: 07/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 38TH ST SW
FARGO ND
58103-4499
US

IV. Provider business mailing address

1701 38TH ST SW
FARGO ND
58103-4499
US

V. Phone/Fax

Practice location:
  • Phone: 701-282-4905
  • Fax: 701-282-9561
Mailing address:
  • Phone: 701-282-4905
  • Fax: 701-282-9561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateND

VIII. Authorized Official

Name: DR. JOEL T. KANGAS
Title or Position: PRESIDENT
Credential: DDS
Phone: 701-282-4905