Healthcare Provider Details

I. General information

NPI: 1376522714
Provider Name (Legal Business Name): RIVER RIDGE ORAL & MAXILLOFACIAL SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S SOUTHEASTERN AVE
SIOUX FALLS SD
57103-3227
US

IV. Provider business mailing address

1700 S SOUTHEASTERN AVE
SIOUX FALLS SD
57103-3227
US

V. Phone/Fax

Practice location:
  • Phone: 605-331-5059
  • Fax: 605-275-6725
Mailing address:
  • Phone: 605-331-5059
  • Fax: 605-275-6725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LINDA K CHRISTENSEN
Title or Position: BUSINESS MANAGER
Credential:
Phone: 605-331-5059