Healthcare Provider Details

I. General information

NPI: 1255000170
Provider Name (Legal Business Name): DAKOTA ADULT & PEDIATRIC PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 02/16/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4541 52ND AVE S STE 100
FARGO ND
58104-5565
US

IV. Provider business mailing address

4541 52ND AVE S STE 100
FARGO ND
58104-5565
US

V. Phone/Fax

Practice location:
  • Phone: 701-552-6578
  • Fax: 701-380-5115
Mailing address:
  • Phone: 701-552-6578
  • Fax: 701-380-5115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier1679864441
Identifier TypeOTHER
Identifier State
Identifier IssuerNPI

VIII. Authorized Official

Name: DR. DOUGLAS JAMES HESS
Title or Position: PRESIDENT
Credential: DO
Phone: 701-552-6578