Healthcare Provider Details

I. General information

NPI: 1023414125
Provider Name (Legal Business Name): DELTA DENTAL OF SOUTH DAKOTA FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 N EUCLID AVE 101
PIERRE SD
57501-1719
US

IV. Provider business mailing address

804 N EUCLID AVE 101
PIERRE SD
57501-1719
US

V. Phone/Fax

Practice location:
  • Phone: 605-494-2548
  • Fax:
Mailing address:
  • Phone: 605-494-2547
  • Fax:

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: CONNIE HALVERSON
Title or Position: VP OF PUBLIC BENEFIT
Credential:
Phone: 605-494-2547