Organization
DAKOTA PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHAD JAMES HOGE DDS (VICE PRESIDENT)
(701) 478-5439
Entity
Organization
Contact information
Practice address
4265 45TH ST S STE 202, FARGO, ND 58104-4309
(701) 478-5439
(701) 364-5440
Mailing address
4265 45TH ST S STE 202, FARGO, ND 58104-4309
(701) 478-5439
(701) 364-5440
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
1998
ND
1223P0221X
Pediatric Dentistry
Primary
2000
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41438
—
ND
Enumeration date
03/11/2008
Last updated
04/15/2009
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