Organization
PAUL A. FREDRIKSON, D.D.S., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL A FREDRIKSON D.D.S., PC (PRESIDENT)
(701) 280-0088
Entity
Organization
Contact information
Practice address
3011 25TH ST S, SUITE 1, FARGO, ND 58103-6162
(701) 280-0088
(701) 293-5602
Mailing address
3011 25TH ST S, SUITE 1, FARGO, ND 58103-6162
(701) 280-0088
(701) 293-5602
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1504
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40631
—
ND
Enumeration date
12/31/2013
Last updated
01/06/2014
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