Healthcare Provider Details

I. General information

NPI: 1003168568
Provider Name (Legal Business Name): AESCHLIMANN PEDIATRIC DENTISTRY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6908 S. LYNCREST PL.
SIOUX FALLS SD
57108
US

IV. Provider business mailing address

27966 452ND AVE
PARKER SD
57053-6003
US

V. Phone/Fax

Practice location:
  • Phone: 605-275-5771
  • Fax: 605-275-5772
Mailing address:
  • Phone: 605-275-5221
  • Fax: 605-275-5772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. LAURA A. AESCHLIMANN
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 605-275-5771