Provider Demographics
NPI:1346541760
Name:FRIENDLY SMILES FAMILY DENTISRTY, PC
Entity Type:Organization
Organization Name:FRIENDLY SMILES FAMILY DENTISRTY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-364-9990
Mailing Address - Street 1:2701 9TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-8712
Mailing Address - Country:US
Mailing Address - Phone:701-364-9990
Mailing Address - Fax:701-364-9992
Practice Address - Street 1:2701 9TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-8712
Practice Address - Country:US
Practice Address - Phone:701-364-9990
Practice Address - Fax:701-364-9992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND19431223G0001X
ND20241223G0001X
ND20391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND41347Medicaid
ND41320Medicaid
ND41457Medicaid
ND41459Medicaid