Organization
IDEAL IMAGE DENTISTRY & SPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FREDRICK A LANDGREBE DDS (OWNER/DENTIST)
(701) 667-1933
Entity
Organization
Contact information
Practice address
1008 E MAIN ST, MANDAN, ND 58554-3762
(701) 667-1933
Mailing address
1008 E MAIN ST, MANDAN, ND 58554-3762
(701) 667-1933
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1593
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41545
—
ND
Enumeration date
01/25/2011
Last updated
01/25/2011
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