Healthcare Provider Details

I. General information

NPI: 1700724994
Provider Name (Legal Business Name): SOUTH DAKOTA DENTAL ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7713 S TOWNSLEY AVE UNIT 5
SIOUX FALLS SD
57108-7669
US

IV. Provider business mailing address

7713 S TOWNSLEY AVE UNIT 5
SIOUX FALLS SD
57108-7669
US

V. Phone/Fax

Practice location:
  • Phone: 740-275-1322
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LUKE NICHOLSON
Title or Position: OWNER
Credential: DMD
Phone: 740-275-1322