# PRAIRIE ORAL SURGERY LTD

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

## Provider details

- **NPI number:** 1598763120
- **Authorized official:** MRS. BETH MARIE JAROSZEWSKI (FINANCE COORDINATOR)
- **Authorized official phone:** (701) 478-4404

## Contact information

- **Practice address:** 2585 23RD AVE S, STE A., FARGO, ND 58103
- **Practice address phone:** (701) 478-4404
- **Practice address fax:** (701) 478-4407
- **Mailing address:** 2585 23RD AVE S, STE. A., FARGO, ND 58104
- **Mailing address phone:** (701) 478-4404
- **Mailing address fax:** (701) 478-4407

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | ND | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 07/08/2005
- **Last updated:** 07/21/2022