# ADVANCED DENTAL TECHNOLOGIES CENTER

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

## Provider details

- **NPI number:** 1114308285
- **Authorized official:** DR. DAVID GORDON BRANT DR. (DENTIST)
- **Authorized official phone:** (701) 280-1020

## Contact information

- **Practice address:** 827 28TH ST S STE A, FARGO, ND 58103-8727
- **Practice address phone:** (701) 280-1020
- **Practice address fax:** (701) 280-1460
- **Mailing address:** 827 28TH ST S STE A, FARGO, ND 58103-8727
- **Mailing address phone:** (701) 280-1020
- **Mailing address fax:** (701) 280-1460

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 1617 | ND | Yes |

## Other

- **Enumeration date:** 06/15/2015
- **Last updated:** 06/15/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 40002 | — | ND |