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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