MEDICARE: DAKOTA PEDIATRIC DENTISTRY PARTNERSHIP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1821761537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAKOTA PEDIATRIC DENTISTRY PARTNERSHIP

Provider Business Mailing Address
First Line	:	3990 S COLUMBIA RD
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-3604
Country	:	US
Telephone Number	:	701-746-1400
Fax Number	:

Provider Business Practice Location Address
First Line	:	3990 S COLUMBIA RD
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-3604
Country	:	US
Telephone Number	:	701-746-1400
Fax Number	:

Authorized Official
Title or Position	:	GENERAL PARTNER
Name	:	CHAD HOGE
Credential	:	DDS
Telephone Number	:	701-200-6394

Provider Enumeration Date	:	07/28/2021
Last Update Date	:	07/28/2021

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