Healthcare Provider Details

I. General information

NPI: 1013639244
Provider Name (Legal Business Name): DAKOTA BEAU PIERCE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8105 RITCHIE HWY
PASADENA MD
21122-3905
US

IV. Provider business mailing address

8816 SW ASH MEADOWS RD UNIT 1227
WILSONVILLE OR
97070-6213
US

V. Phone/Fax

Practice location:
  • Phone: 443-573-0564
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0010521
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA212388
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: