Healthcare Provider Details

I. General information

NPI: 1285747881
Provider Name (Legal Business Name): KEITH ALAN VENHUIZEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 BRADOCK STREET
ARMOUR SD
57313-0189
US

IV. Provider business mailing address

1210 BRADDOCK STREET BOX 189
ARMOUR SD
57313-0189
US

V. Phone/Fax

Practice location:
  • Phone: 605-724-2402
  • Fax: 605-724-2491
Mailing address:
  • Phone: 605-724-2402
  • Fax: 605-724-2491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberM-586
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: