Provider Demographics
NPI:1598076119
Name:BAILLARGEON MARX, BETHANY L (DDS)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:L
Last Name:BAILLARGEON MARX
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 44TH STREET SOUTH
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104
Mailing Address - Country:US
Mailing Address - Phone:701-235-2860
Mailing Address - Fax:701-235-4179
Practice Address - Street 1:22 5TH AVE NE
Practice Address - Street 2:
Practice Address - City:PELICAN RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56572-4126
Practice Address - Country:US
Practice Address - Phone:218-863-7511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2232122300000X
MO2011039028122300000X
WI65071223G0001X
MND13461122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice