Healthcare Provider Details

I. General information

NPI: 1740430198
Provider Name (Legal Business Name): DAKOTA SMILES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3170 44TH ST S STE 100
FARGO ND
58104
US

IV. Provider business mailing address

3170 44TH ST S STE 100
FARGO ND
58104
US

V. Phone/Fax

Practice location:
  • Phone: 701-235-2860
  • Fax: 701-235-4179
Mailing address:
  • Phone: 701-235-2860
  • Fax: 701-235-4179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number2038
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES CHRISTOPHER DUCHSHERER
Title or Position: CO-OWNER
Credential: DDS
Phone: 701-235-2860