Healthcare Provider Details

I. General information

NPI: 1922202100
Provider Name (Legal Business Name): JOHN P TAGGART DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3813 S KIWANIS CIR
SIOUX FALLS SD
57105-4266
US

IV. Provider business mailing address

3813 S KIWANIS CIR
SIOUX FALLS SD
57105-4266
US

V. Phone/Fax

Practice location:
  • Phone: 605-332-1095
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD0641
License Number StateSD

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: