Individual
ETERN S PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MD
Contact information
Practice address
1717 UNIVERSITY DR S, FARGO, ND 58103-4939
(701) 234-2000
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
(605) 328-6585
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
053210
NY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
2503
ND
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
C1-0011804
DE
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
G3-0000458
DE
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
21037
ND
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
269333
NY
Other
Enumeration date
06/24/2008
Last updated
02/11/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us