Healthcare Provider Details

I. General information

NPI: 1275391278
Provider Name (Legal Business Name): NORTH UNIVERSITY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 19TH AVE N
FARGO ND
58102-2201
US

IV. Provider business mailing address

1115 19TH AVE N
FARGO ND
58102-2201
US

V. Phone/Fax

Practice location:
  • Phone: 701-293-8625
  • Fax:
Mailing address:
  • Phone: 701-293-8625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHAD BERGAN
Title or Position: OWNER/DDS
Credential: DDS
Phone: 701-232-8884