Healthcare Provider Details

I. General information

NPI: 1881893972
Provider Name (Legal Business Name): SMALLCOMB DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 S CLIFF AVE
SIOUX FALLS SD
57108-5475
US

IV. Provider business mailing address

5100 S CLIFF AVE
SIOUX FALLS SD
57108-5475
US

V. Phone/Fax

Practice location:
  • Phone: 605-371-9111
  • Fax:
Mailing address:
  • Phone: 605-371-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberM857
License Number StateSD

VIII. Authorized Official

Name: DR. JOHN SMALLCOMB
Title or Position: PRESIDENT
Credential: DMD
Phone: 605-371-9111