Healthcare Provider Details

I. General information

NPI: 1518962943
Provider Name (Legal Business Name): LANCE REED GRIESE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E 7TH ST
PLATTE SD
57369-2123
US

IV. Provider business mailing address

PO BOX 250
PLATTE SD
57369-0250
US

V. Phone/Fax

Practice location:
  • Phone: 605-337-3810
  • Fax: 605-337-2617
Mailing address:
  • Phone: 605-337-3810
  • Fax: 605-337-2617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberM683
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: