MEDICARE: PETER M SETHERLAND DDS LTD

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	M558	SD

General Provider Information

NPI Number	:	1881625085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER M SETHERLAND DDS LTD

Provider Business Mailing Address
First Line	:	110 N CHICAGO ST
Second Line	:
City	:	HOT SPRINGS
State	:	SD
Zip	:	57747-1632
Country	:	US
Telephone Number	:	605-745-5776
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 N CHICAGO ST
Second Line	:
City	:	HOT SPRINGS
State	:	SD
Zip	:	57747-1632
Country	:	US
Telephone Number	:	605-745-5776
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PETER MICHAEL SOTHERLAND
Credential	:	DDS
Telephone Number	:	605-745-5776

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	08/22/2020

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