Provider Demographics
NPI:1740386853
Name:ROSENFELDT, SHANDRA DEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANDRA
Middle Name:DEE
Last Name:ROSENFELDT
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 1:3633 LINCOLN ST S STE C
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7771
Mailing Address - Country:US
Mailing Address - Phone:701-373-0681
Mailing Address - Fax:701-373-0684
Practice Address - Street 1:3633 LINCOLN ST S STE C
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7771
Practice Address - Country:US
Practice Address - Phone:701-373-0681
Practice Address - Fax:701-373-0684
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND121121223G0001X
ND19651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1850732OtherUNITED CONCORDIA
ND949311OtherDENTAL SERVICE CORP OF ND