Healthcare Provider Details

I. General information

NPI: 1447429121
Provider Name (Legal Business Name): RICK WALLACE FUCHS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 ARIZONA AVE SW
HURON SD
57350
US

IV. Provider business mailing address

2080 ARIZONA AVE SW
HURON SD
57350
US

V. Phone/Fax

Practice location:
  • Phone: 605-352-1670
  • Fax:
Mailing address:
  • Phone: 605-352-1670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD0625
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: