# PAUL A. FREDRIKSON, D.D.S., P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003237512
- **Authorized official:** PAUL A FREDRIKSON D.D.S., PC (PRESIDENT)
- **Authorized official phone:** (701) 280-0088

## Contact information

- **Practice address:** 3011 25TH ST S, SUITE 1, FARGO, ND 58103-6162
- **Practice address phone:** (701) 280-0088
- **Practice address fax:** (701) 293-5602
- **Mailing address:** 3011 25TH ST S, SUITE 1, FARGO, ND 58103-6162
- **Mailing address phone:** (701) 280-0088
- **Mailing address fax:** (701) 293-5602

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 1504 | ND | Yes |

## Other

- **Enumeration date:** 12/31/2013
- **Last updated:** 01/06/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 40631 | — | ND |