Healthcare Provider Details

I. General information

NPI: 1295643252
Provider Name (Legal Business Name): BLACK HILLS ORAL SURGERY AND DENTAL IMPLANT CENTER, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 5TH ST
RAPID CITY SD
57701-7365
US

IV. Provider business mailing address

3415 5TH ST
RAPID CITY SD
57701-7365
US

V. Phone/Fax

Practice location:
  • Phone: 605-348-6818
  • Fax: 605-348-4690
Mailing address:
  • Phone: 605-348-6818
  • Fax: 605-348-4690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: KARI L SIMONSON
Title or Position: PRACTICE MANAGER
Credential:
Phone: 605-348-6818