Healthcare Provider Details

I. General information

NPI: 1447291174
Provider Name (Legal Business Name): GENERAL DENTISTRY, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3508 S MINNESOTA AVE SUITE #108
SIOUX FALLS SD
57105-6461
US

IV. Provider business mailing address

3508 S MINNESOTA AVE SUITE #108
SIOUX FALLS SD
57105-6461
US

V. Phone/Fax

Practice location:
  • Phone: 605-339-1381
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberM420
License Number StateSD

VIII. Authorized Official

Name: DR. BRIAN R SATHER
Title or Position: PRESIDENT
Credential:
Phone: 605-339-1381