Healthcare Provider Details

I. General information

NPI: 1962967455
Provider Name (Legal Business Name): DAKOTA FAMILY DENTISTRY, PROF. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 DAKOTA AVE S
HURON SD
57350-3318
US

IV. Provider business mailing address

1010 DAKOTA AVE S
HURON SD
57350-3318
US

V. Phone/Fax

Practice location:
  • Phone: 605-352-6999
  • Fax: 605-352-0472
Mailing address:
  • Phone: 605-352-6999
  • Fax: 605-352-0472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSE DAVID FAST
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 605-352-6999