MEDICARE: PILLAR DENTAL WEST LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	M0626	SD

General Provider Information

NPI Number	:	1124314661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PILLAR DENTAL WEST LLC

Provider Business Mailing Address
First Line	:	5208 W 26TH ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-3513
Country	:	US
Telephone Number	:	605-271-4422
Fax Number	:

Provider Business Practice Location Address
First Line	:	5208 W 26TH ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-3513
Country	:	US
Telephone Number	:	605-271-4422
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	THOMAS E. PILLAR
Credential	:	D.D.S.
Telephone Number	:	605-271-4422

Provider Enumeration Date	:	06/23/2011
Last Update Date	:	06/23/2011

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