Healthcare Provider Details

I. General information

NPI: 1922931617
Provider Name (Legal Business Name): AURELIA GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 E GATEWAY BLVD SUITE A
TEA SD
57201
US

IV. Provider business mailing address

1930 E GATEWAY BLVD SUITE A
TEA SD
57201
US

V. Phone/Fax

Practice location:
  • Phone: 605-949-0507
  • Fax:
Mailing address:
  • Phone: 605-949-0507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. SYDNEY EBBEN-CARMODY
Title or Position: DENTIST
Credential: DDS
Phone: 605-949-0507