Healthcare Provider Details

I. General information

NPI: 1902641533
Provider Name (Legal Business Name): SCEPANIAK & LEDEBOER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 FOUBERG ST S
ABERDEEN SD
57401-5255
US

IV. Provider business mailing address

25 FOUBERG ST S
ABERDEEN SD
57401-5255
US

V. Phone/Fax

Practice location:
  • Phone: 605-725-1500
  • Fax:
Mailing address:
  • Phone: 605-725-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: ALEAHA FETTIG LEDEBOER
Title or Position: DENTIST/OWNER
Credential:
Phone: 701-290-4979