NPI 1174758361 · live from the CMS NPI Registry
Bradley Jon Anderson, D.D.S
Dentist, General Practice in Fargo, ND. National Provider Identifier 1174758361, active.
NPI record
| NPI | 1174758361 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dentist, General Practice 1223G0001X |
| Practice location | 4521 38th Ave S, Fargo, ND 58104 |
| Practice phone | 701-232-1368 |
| Enumerated | May 18, 2009 |
| Last updated | May 18, 2009 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist, General Practice primary | 1223G0001X | 2045 (ND) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.