Organization
ADVANCED DENTAL TECHNOLOGIES CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID GORDON BRANT DR. (DENTIST)
(701) 280-1020
Entity
Organization
Contact information
Practice address
827 28TH ST S STE A, FARGO, ND 58103-8727
(701) 280-1020
(701) 280-1460
Mailing address
827 28TH ST S STE A, FARGO, ND 58103-8727
(701) 280-1020
(701) 280-1460
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1617
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40002
—
ND
Enumeration date
06/15/2015
Last updated
06/15/2015
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