Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 2025 | ND |
N | 204E00000X | Oral & Maxillofacial Surgeon | 11700 | MN |
N | 204E00000X | Oral & Maxillofacial Surgeon | 49823 | MN |
NPI | 1538147848 |
---|---|
Provider Name | Michael J Noffze |
First Address | Fargo, ND 58104-8805 |
Second Address | Fargo, ND 58104-8805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2006 |
Last Update Date | 24/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
717683000 | (05) | MN |
U92047 | (02) |