Healthcare Provider Details

I. General information

NPI: 1487639316
Provider Name (Legal Business Name): BRUCE EVAN PARTNOY DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 S CLIFF AVE SUITE 102
SIOUX FALLS SD
57108
US

IV. Provider business mailing address

5200 S CLIFF AVE SUITE 102
SIOUX FALLS SD
57108
US

V. Phone/Fax

Practice location:
  • Phone: 605-271-7135
  • Fax: 605-271-7137
Mailing address:
  • Phone: 605-271-7135
  • Fax: 605-271-7137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberM771
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: