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General NPI Number Information
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NPI Number | 1760621387
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Entity Type | Organization
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Legal Business Name | BRIAN R JESPERSON, DDS, MS, PC
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Dates
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Enumeration Date | 02/05/2009
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Last Update Date | 02/05/2009
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Provider Practice Location Address
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Address Line | 531 S 7TH ST
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City | BISMARCK
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State | ND
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Zip | 58504-5859
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Country | US
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Telephone | 701-224-1558
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Fax | 701-224-1093
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Provider Business Mailing Address
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Address Line | 531 S 7TH ST
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City | BISMARCK
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State | ND
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Zip | 58504-5859
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Country | US
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Telephone | 701-224-1558
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Fax | 701-224-1093
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. BRIAN R JESPERSON
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Credential | DDS, MS, PC
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Telephone | 701-224-1558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 1634
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License Number State | ND
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