Individual
PAUL H IVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1702 UNIVERSITY DR S, FARGO, ND 58103-4940
(701) 364-3300
(701) 364-8906
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(701) 364-3300
(701) 364-8906
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
1404
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1120
NDBS #
ND
01
—
115958
UCARE#
ND
05
—
17824
—
ND
05
—
274817700
—
ND
01
—
676709
AMERICA'S PPO/ARAZ #
ND
01
—
8600235
MEDICA #
ND
01
—
8600256
MEDICA #
ND
01
—
91802IV
MNBS #
ND
01
—
DA9011015544
PREFERRED ONE #
ND
01
—
HP38639
HEALTHPARTNERS #
ND
01
—
ND200029
LHS #
ND
Enumeration date
07/11/2006
Last updated
09/22/2011
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