Provider Demographics
NPI:1346811965
Name:DAKOTA PEDIATRIC DENTISTRY PARTNERSHIP
Entity Type:Organization
Organization Name:DAKOTA PEDIATRIC DENTISTRY PARTNERSHIP
Other - Org Name:DAKOTA PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HOGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-478-5439
Mailing Address - Street 1:4423 45TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4491
Mailing Address - Country:US
Mailing Address - Phone:701-478-5439
Mailing Address - Fax:701-364-5440
Practice Address - Street 1:4423 45TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4491
Practice Address - Country:US
Practice Address - Phone:701-478-5439
Practice Address - Fax:701-364-5440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty