Provider Demographics
NPI:1952502510
Name:VOLKERDING, JOHN ALLAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALLAN
Last Name:VOLKERDING
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 1:24667 N MELISSA DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-7263
Mailing Address - Country:US
Mailing Address - Phone:218-847-6268
Mailing Address - Fax:
Practice Address - Street 1:2834 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6030
Practice Address - Country:US
Practice Address - Phone:701-293-9886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1403122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist