Organization Name:  DAKOTA CLINIC, LTD.


Practice Location:
1702 UNIVERSITY DR S  FARGO, ND 58103 US
Tel: 701-364-3300  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
X	204E00000X	Physicians Oral & Maxillofacial Surgery
X	207L00000X	Physicians Anesthesiology
X	207P00000X	Physicians Emergency Medicine
X	207Q00000X	Physicians Family Medicine
X	207R00000X	Physicians Internal Medicine
X	207T00000X	Physicians Neurological Surgery
X	207V00000X	Physicians Obstetrics & Gynecology
X	207N00000X	Physicians Dermatology
X	207W00000X	Physicians Ophthalmology
X	207X00000X	Physicians Orthopaedic Surgery
X	207ZH0000X	Physicians Pathology
X	208000000X	Physicians Pediatrics
X	2084N0400X	Physicians Psychiatry & Neurology
X	2085R0202X	Physicians Radiology
X	208600000X	Physicians Surgery

Other Provider Identifiers:

Issuer	Number	State	Type
	10046	ND	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin