Healthcare Provider Details

I. General information

NPI: 1003199829
Provider Name (Legal Business Name): PLAINS EAR, NOSE, THROAT & FACIAL PLASTIC SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 23RD AVE E STE 102
WEST FARGO ND
58078-7401
US

IV. Provider business mailing address

350 23RD AVE E STE 102
WEST FARGO ND
58078-7401
US

V. Phone/Fax

Practice location:
  • Phone: 701-235-1924
  • Fax: 701-235-6304
Mailing address:
  • Phone: 701-235-1924
  • Fax: 701-235-6304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number10000
License Number StateND

VIII. Authorized Official

Name: DR. LESLEY A SOINE
Title or Position: OWNER
Credential: MD
Phone: 701-235-1924