Provider Demographics
NPI:1275391278
Name:NORTH UNIVERSITY DENTAL
Entity Type:Organization
Organization Name:NORTH UNIVERSITY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DDS
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-232-8884
Mailing Address - Street 1:1115 19TH AVE N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-2201
Mailing Address - Country:US
Mailing Address - Phone:701-293-8625
Mailing Address - Fax:
Practice Address - Street 1:1115 19TH AVE N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2201
Practice Address - Country:US
Practice Address - Phone:701-293-8625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental