Provider Demographics
NPI:1619185824
Name:DAKOTA DENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:DAKOTA DENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FISHPAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-852-4755
Mailing Address - Street 1:515 20TH AVE SE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-6661
Mailing Address - Country:US
Mailing Address - Phone:701-852-4755
Mailing Address - Fax:701-852-8016
Practice Address - Street 1:515 20TH AVE SE
Practice Address - Street 2:SUITE 8
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-6661
Practice Address - Country:US
Practice Address - Phone:701-852-4755
Practice Address - Fax:701-852-8016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND41393Medicaid