Organization
GREAT PLAINS PERIODONTICS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TODD WILLIAM NEILS D.D.S. (PRESIDENT)
(701) 293-0577
Entity
Organization
Contact information
Practice address
2838 SOUTH UNIVERSITY DRIVE, FARGO, ND 58103-6030
(701) 293-0577
(701) 293-0910
Mailing address
2838 SOUTH UNIVERSITY DRIVE, FARGO, ND 58103-6030
(701) 293-0577
(701) 293-0910
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
1786
ND
Other
Enumeration date
02/06/2009
Last updated
02/06/2009
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