Healthcare Provider Details

I. General information

NPI: 1285074997
Provider Name (Legal Business Name): DAVID RETTEDAL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 08/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 N SIOUX POINT RD
DAKOTA DUNES SD
57049-5312
US

IV. Provider business mailing address

7337 DODGE ST
OMAHA NE
68114-3613
US

V. Phone/Fax

Practice location:
  • Phone: 605-217-2667
  • Fax: 605-217-2900
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number358
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number081746
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number230
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: