Healthcare Provider Details

I. General information

NPI: 1154633667
Provider Name (Legal Business Name): JENNIFER MARIE DAY D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 1ST ST NE STE 2
WESSINGTON SPRINGS SD
57382-2163
US

IV. Provider business mailing address

602 1ST ST NE STE 2
WESSINGTON SPRINGS SD
57382-2163
US

V. Phone/Fax

Practice location:
  • Phone: 605-539-1381
  • Fax: 605-539-1190
Mailing address:
  • Phone: 605-539-1381
  • Fax: 605-539-1190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number283
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: