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General NPI Number Information
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NPI Number | 1063618015
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Entity Type | Organization
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Legal Business Name | DANA ORTHODONTICS
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1306 N MAIN ST
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City | SPEARFISH
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State | SD
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Zip | 57783-1503
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Country | US
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Telephone | 605-717-2722
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Fax |
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Provider Business Mailing Address
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Address Line | 1306 N MAIN ST
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City | SPEARFISH
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State | SD
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Zip | 57783-1503
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Country | US
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Telephone | 605-717-2722
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JESSE M DANA
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Credential | DDS
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Telephone | 605-717-2722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | M961
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License Number State | SD
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