MEDICARE: SOUTH DAKOTA DENTAL ANESTHESIA 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1700724994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH DAKOTA DENTAL ANESTHESIA LLC

Provider Business Mailing Address
First Line	:	7713 S TOWNSLEY AVE UNIT 5
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-7669
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7713 S TOWNSLEY AVE UNIT 5
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-7669
Country	:	US
Telephone Number	:	740-275-1322
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LUKE NICHOLSON
Credential	:	DMD
Telephone Number	:	740-275-1322

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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