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Organization
SOUTH UNIVERSITY DENTAL ASSOCIATES, PC
Active
Organization
SOUTH UNIVERSITY DENTAL ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS GLEN FELLMAN DDS (PRESIDENT)
(701) 232-8884
Entity
Organization
Contact information
Practice address
3115 UNIVERSITY DR S, FARGO, ND 58103-6049
(701) 232-8884
(701) 232-6064
Mailing address
3115 UNIVERSITY DR S, FARGO, ND 58103-6049
(701) 232-8884
(701) 232-6064
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
1493
ND
261QD0000X
Dental Clinic/Center
1843
ND
261QD0000X
Dental Clinic/Center
2068
ND
Other
Enumeration date
12/29/2010
Last updated
12/29/2010
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