Provider Demographics
NPI:1578898268
Name:DAKOTA PEDIATRIC DENTISTRY PC
Entity Type:Organization
Organization Name:DAKOTA PEDIATRIC DENTISTRY PC
Other - Org Name:DENTAL CARE 4 KIDZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
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:701-200-5771
Mailing Address - Street 1:2812 17TH AVE S
Mailing Address - Street 2:SUITE F
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4048
Mailing Address - Country:US
Mailing Address - Phone:701-746-1400
Mailing Address - Fax:
Practice Address - Street 1:2812 17TH AVE S
Practice Address - Street 2:SUITE F
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4048
Practice Address - Country:US
Practice Address - Phone:701-746-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2000261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental