Healthcare Provider Details

I. General information

NPI: 1083577746
Provider Name (Legal Business Name): DOMINIQUE YELLOWHAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 CANYON LAKE DR
RAPID CITY SD
57702-8114
US

IV. Provider business mailing address

HC 63 BOX 253
WINSLOW AZ
86047-9417
US

V. Phone/Fax

Practice location:
  • Phone: 605-355-2260
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD1507
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: