Provider Demographics
NPI:1578791117
Name:TRONSGARD AND SULLIVAN DDS PARTNERSHIP
Entity Type:Organization
Organization Name:TRONSGARD AND SULLIVAN DDS PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-232-6983
Mailing Address - Street 1:1231 27TH ST S STE C
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-8722
Mailing Address - Country:US
Mailing Address - Phone:701-232-6983
Mailing Address - Fax:701-239-9375
Practice Address - Street 1:1231 27TH ST S STE C
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-8722
Practice Address - Country:US
Practice Address - Phone:701-232-6983
Practice Address - Fax:701-239-9375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X, 261QD0000X
ND17961223G0001X
ND20561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1460606Medicaid
ND41503Medicaid
ND1484520Medicaid