Healthcare Provider Details

I. General information

NPI: 1457389199
Provider Name (Legal Business Name): PLASTIC SURGERY ASSOCIATES OF SOUTH DAKOTA, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SOUTH MINNESOTA AVENUE STE. 112
SIOUX FALLS SD
57105-6706
US

IV. Provider business mailing address

4201 SOUTH MINNESOTA AVE., STE 112
SIOUX FALLS SD
57105
US

V. Phone/Fax

Practice location:
  • Phone: 605-335-3349
  • Fax:
Mailing address:
  • Phone: 605-335-3349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MARVIN SMOOT
Title or Position: ADMINISTRATOR
Credential:
Phone: 605-335-3349