Healthcare Provider Details

I. General information

NPI: 1255060083
Provider Name (Legal Business Name): JOSEPH JUSTIN MCNISH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 07/05/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 N MAIN AVE
SIOUX FALLS SD
57104-5948
US

IV. Provider business mailing address

PO BOX 386
MARYSVILLE KS
66508-0386
US

V. Phone/Fax

Practice location:
  • Phone: 605-367-8793
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7804
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD1369
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number62124
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: