Provider Demographics
NPI:1760621387
Name:BRIAN R JESPERSON, DDS, MS, PC
Entity Type:Organization
Organization Name:BRIAN R JESPERSON, DDS, MS, PC
Other - Org Name:JESPERSON ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:JESPERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, PC
Authorized Official - Phone:701-224-1558
Mailing Address - Street 1:531 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5859
Mailing Address - Country:US
Mailing Address - Phone:701-224-1558
Mailing Address - Fax:701-224-1093
Practice Address - Street 1:531 S 7TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5859
Practice Address - Country:US
Practice Address - Phone:701-224-1558
Practice Address - Fax:701-224-1093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND16341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1634OtherDSC
ND40839Medicaid