Healthcare Provider Details

I. General information

NPI: 1003213182
Provider Name (Legal Business Name): URBAN DENTAL HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3424 2ND ST E
WEST FARGO ND
58078-7947
US

IV. Provider business mailing address

3424 2ND ST E
WEST FARGO ND
58078-7947
US

V. Phone/Fax

Practice location:
  • Phone: 701-412-3600
  • Fax:
Mailing address:
  • Phone: 701-412-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1974
License Number StateND

VIII. Authorized Official

Name: DR. CHRISTOPHER ALGOT ERIKSSON
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 701-353-2100