Provider Demographics
NPI:1538147848
Name:NOFFZE, MICHAEL J (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:NOFFZE
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 1:2856 BRANDT DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8805
Mailing Address - Country:US
Mailing Address - Phone:701-232-9565
Mailing Address - Fax:701-298-0853
Practice Address - Street 1:2856 BRANDT DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8805
Practice Address - Country:US
Practice Address - Phone:701-232-9565
Practice Address - Fax:701-298-0853
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11700204E00000X
MN49823204E00000X
ND20251223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN717683000Medicaid
MN717683000Medicaid
MN850000102Medicare PIN