Healthcare Provider Details

I. General information

NPI: 1285215376
Provider Name (Legal Business Name): BENJAMIN GILLETTE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 S CLIFF AVE STE 300
SIOUX FALLS SD
57105-1062
US

IV. Provider business mailing address

1417 S CLIFF AVE STE 300
SIOUX FALLS SD
57105-1062
US

V. Phone/Fax

Practice location:
  • Phone: 605-504-3000
  • Fax:
Mailing address:
  • Phone: 605-504-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: