Healthcare Provider Details

I. General information

NPI: 1750633004
Provider Name (Legal Business Name): DAKOTA ENT AND SINUS CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6709 S MINNESOTA AVE SUITE 206
SIOUX FALLS SD
57108-2592
US

IV. Provider business mailing address

6709 S MINNESOTA AVE SUITE 206
SIOUX FALLS SD
57108-2592
US

V. Phone/Fax

Practice location:
  • Phone: 605-575-1000
  • Fax: 605-575-1004
Mailing address:
  • Phone: 605-575-1000
  • Fax: 605-575-1004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK GREGORY DESAUTEL
Title or Position: OWNER
Credential: MD
Phone: 605-575-1000