Provider Demographics
NPI:1801181235
Name:BADGER, JEREMY SETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:SETH
Last Name:BADGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1197 S COLUMBIA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4033
Mailing Address - Country:US
Mailing Address - Phone:701-775-4751
Mailing Address - Fax:701-746-4931
Practice Address - Street 1:1197 S COLUMBIA RD
Practice Address - Street 2:SUITE A
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4033
Practice Address - Country:US
Practice Address - Phone:701-775-4751
Practice Address - Fax:701-746-4931
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2107122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist