Healthcare Provider Details

I. General information

NPI: 1215544333
Provider Name (Legal Business Name): BLACK HILLS SLEEP & TMJ SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 02/21/2024
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 HOPE CT STE 4
RAPID CITY SD
57701-1055
US

IV. Provider business mailing address

2001 HOPE CT STE 4
RAPID CITY SD
57701-1055
US

V. Phone/Fax

Practice location:
  • Phone: 605-718-0155
  • Fax: 605-626-8568
Mailing address:
  • Phone: 605-718-0155
  • Fax: 605-626-8568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BRIAN CRISS
Title or Position: OWNER
Credential:
Phone: 605-718-0155