Provider Demographics
NPI:1285943027
Name:DAKOTA PEDIATRICS, P.A.
Entity type:Organization
Organization Name:DAKOTA PEDIATRICS, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEEB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-455-9697
Mailing Address - Street 1:5975 CARMEN AVE
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-4416
Mailing Address - Country:US
Mailing Address - Phone:651-455-9697
Mailing Address - Fax:651-455-2012
Practice Address - Street 1:5975 CARMEN AVE
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-4416
Practice Address - Country:US
Practice Address - Phone:651-455-9697
Practice Address - Fax:651-455-2012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1693555261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care