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General NPI Number Information
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NPI Number | 1326918889
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Entity Type | Individual
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Provider Name | TERESA FRADET
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Gender | Female
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Dates
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Enumeration Date | 11/10/2025
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 2101 ELM ST N
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City | FARGO
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State | ND
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Zip | 58102-2417
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Country | US
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Telephone | 701-232-3241
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Fax |
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Provider Business Mailing Address
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Address Line | 506 S ADAMS ST
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City | RAYMORE
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State | MO
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Zip | 64083-9178
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 12410
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2001021353
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License Number State | MO
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