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General NPI Number Information
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NPI Number | 1215278676
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Entity Type | Organization
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Legal Business Name | ANDERSON & BREDING DENTAL LLC
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Dates
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Enumeration Date | 03/11/2013
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Last Update Date | 09/25/2020
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Provider Practice Location Address
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Address Line | 4521 38TH AVE. S.
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City | FARGO
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State | ND
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Zip | 58104
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Country | US
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Telephone | 701-232-1368
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Fax | 701-232-4746
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Provider Business Mailing Address
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Address Line | 4521 38TH AVE. S.
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City | FARGO
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State | ND
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Zip | 58104
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Country | US
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Telephone | 701-232-1368
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Fax | 701-232-4746
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. BRADLEY JON ANDERSON
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Credential | DDS
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Telephone | 701-232-1368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | ND1601
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | ND2045
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License Number State | ND
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