Healthcare Provider Details

I. General information

NPI: 1508164401
Provider Name (Legal Business Name): BECHTOLD THOMPSON DENTAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 E. SIOUX AVE
PIERRE SD
57501
US

IV. Provider business mailing address

640 E. SIOUX AVE
PIERRE SD
57501
US

V. Phone/Fax

Practice location:
  • Phone: 605-224-5355
  • Fax: 605-224-4846
Mailing address:
  • Phone: 605-224-5355
  • Fax: 605-224-4846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD0513
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberM583
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MONTY D. BECHTOLD
Title or Position: CO-OWNER
Credential:
Phone: 605-224-5355