Healthcare Provider Details

I. General information

NPI: 1689859977
Provider Name (Legal Business Name): DELTA DENTAL OF SOUTH DAKOTA FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 N EUCLID AVE STE 1
PIERRE SD
57501-1719
US

IV. Provider business mailing address

804 N EUCLID AVE STE 1
PIERRE SD
57501-1738
US

V. Phone/Fax

Practice location:
  • Phone: 605-224-7345
  • Fax: 605-224-0909
Mailing address:
  • Phone: 605-494-2547
  • Fax: 605-224-2578

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