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General NPI Number Information
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NPI Number | 1992914055
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Entity Type | Organization
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Legal Business Name | FARGO FAMILY DENTISTRY PC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3210 18TH ST SO SUITE B
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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 | 701-237-6008
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Fax | 701-893-3017
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Provider Business Mailing Address
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Address Line | 3210 18TH ST SO SUITE B
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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 | 701-237-6008
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Fax | 701-893-3017
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Authorized Official
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Title or Position | DENTIST PRESIDENT
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Name | DR. JAMES J COLBERT
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Credential | DDS
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Telephone | 701-237-6008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1879 ND
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License Number State | ND
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