Healthcare Provider Details

I. General information

NPI: 1730107491
Provider Name (Legal Business Name): MARK H HENLINE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 PINE ST
RAPID CITY SD
57701-1669
US

IV. Provider business mailing address

350 PINE ST
RAPID CITY SD
57701-1669
US

V. Phone/Fax

Practice location:
  • Phone: 605-721-8939
  • Fax: 605-721-8998
Mailing address:
  • Phone: 605-721-8939
  • Fax: 605-721-8998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD1267
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30-017513
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: