Healthcare Provider Details

I. General information

NPI: 1972474054
Provider Name (Legal Business Name): DAKOTA PEDIATRIC ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3284 51ST ST S UNIT 3
FARGO ND
58104-7983
US

IV. Provider business mailing address

1036 36TH STREET CIR S
MOORHEAD MN
56560-8111
US

V. Phone/Fax

Practice location:
  • Phone: 701-532-2242
  • Fax: 701-532-2518
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BRENNAN FORWARD
Title or Position: CO-OWNER
Credential: MD
Phone: 218-790-6111