Individual
BENJAMIN LANE DAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-5015
Mailing address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-5015
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
Primary
11490
ND
2085R0202X
Diagnostic Radiology Physician
11490
ND
390200000X
Student in an Organized Health Care Education/Training Program
2004015303
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
15406
—
ND
Enumeration date
06/12/2007
Last updated
11/23/2020
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