Healthcare Provider Details

I. General information

NPI: 1376756163
Provider Name (Legal Business Name): SMILE SOLUTIONS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 23RD ST S SUITE 2A
FARGO ND
58103-3702
US

IV. Provider business mailing address

1910 42ND ST S SUITE A
FARGO ND
58103-4416
US

V. Phone/Fax

Practice location:
  • Phone: 701-365-0507
  • Fax: 701-365-0009
Mailing address:
  • Phone: 701-365-0507
  • Fax: 701-365-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number1959
License Number StateND

VIII. Authorized Official

Name: DR. JEREMY P WEHRMAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 701-365-0507