NPI 1770744690 · live from the CMS NPI Registry
Tanya Bonicelli, D.D.S.
Dentist, General Practice in Fargo, ND. National Provider Identifier 1770744690, active.
NPI record
| NPI | 1770744690 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dentist, General Practice 1223G0001X |
| Practice location | 4302 13th Ave S, Fargo, ND 58103 |
| Practice phone | 701-277-3269 |
| Enumerated | June 23, 2008 |
| Last updated | October 27, 2008 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist, General Practice primary | 1223G0001X | 2027 (ND) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.