Healthcare Provider Details

I. General information

NPI: 1801810585
Provider Name (Legal Business Name): DUNES ANESTHESIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 TOWER RD SUITE 103
DAKOTA DUNES SD
57049-5007
US

IV. Provider business mailing address

101 TOWER RD STE 103
DAKOTA DUNES SD
57049-5007
US

V. Phone/Fax

Practice location:
  • Phone: 605-242-7246
  • Fax: 605-242-3474
Mailing address:
  • Phone: 605-339-6525
  • Fax: 605-339-2905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: TODD C JOHNSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 605-242-7246