Individual
BRIAN COLE MATHISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4742 AMBER VALLEY PKWY S, FARGO, ND 58104-8614
(701) 356-3999
(701) 356-4088
Mailing address
4742 AMBER VALLEY PKWY S, FARGO, ND 58104-8614
(701) 356-3999
(701) 356-4088
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1887
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
971887
DENTAL SERVIC CORP
ND
Enumeration date
08/13/2006
Last updated
12/19/2012
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