Healthcare Provider Details

I. General information

NPI: 1881625085
Provider Name (Legal Business Name): PETER M SETHERLAND DDS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N CHICAGO ST
HOT SPRINGS SD
57747-1632
US

IV. Provider business mailing address

110 N CHICAGO ST
HOT SPRINGS SD
57747-1632
US

V. Phone/Fax

Practice location:
  • Phone: 605-745-5776
  • Fax:
Mailing address:
  • Phone: 605-745-5776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberM558
License Number StateSD

VIII. Authorized Official

Name: DR. PETER MICHAEL SOTHERLAND
Title or Position: OWNER
Credential: DDS
Phone: 605-745-5776