Healthcare Provider Details

I. General information

NPI: 1326295361
Provider Name (Legal Business Name): ERICK RATH DDS PHD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 S CENTRAL AVE
PIERRE SD
57501-4508
US

IV. Provider business mailing address

433 S CENTRAL AVE
PIERRE SD
57501-4508
US

V. Phone/Fax

Practice location:
  • Phone: 605-224-5966
  • Fax:
Mailing address:
  • Phone: 605-224-5966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberM929
License Number StateSD

VIII. Authorized Official

Name: ERICK RATH
Title or Position: OWNER
Credential: DDS PHD
Phone: 605-224-5966