Provider Demographics
NPI:1942464888
Name:NICHOLAS C. DORSHER, D.D.S., LTD.
Entity Type:Organization
Organization Name:NICHOLAS C. DORSHER, D.D.S., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERDENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:DORSHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-237-4331
Mailing Address - Street 1:118 BROADWAY N STE 711
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-4948
Mailing Address - Country:US
Mailing Address - Phone:701-237-4331
Mailing Address - Fax:701-365-2000
Practice Address - Street 1:118 BROADWAY N STE 711
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4948
Practice Address - Country:US
Practice Address - Phone:701-237-4331
Practice Address - Fax:701-365-2000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND19301223G0001X
ND20271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDND41389Medicaid