Provider Demographics
NPI:1124377296
Name:DAKOTA CHILD AND FAMILY CLINIC PA
Entity Type:Organization
Organization Name:DAKOTA CHILD AND FAMILY CLINIC PA
Other - Org Name:DAKOTA CHILD AND FAMILY CLINIC PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL BILLING
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-209-8640
Mailing Address - Street 1:2530 HORIZON DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-3091
Mailing Address - Country:US
Mailing Address - Phone:651-209-8640
Mailing Address - Fax:
Practice Address - Street 1:2530 HORIZON DR
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-3091
Practice Address - Country:US
Practice Address - Phone:651-209-8640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1854261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center