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General NPI Number Information
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NPI Number | 1083577746
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Entity Type | Individual
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Provider Name | DOMINIQUE YELLOWHAIR
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Gender | Female
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Dates
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Enumeration Date | 12/08/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 3200 CANYON LAKE DR
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City | RAPID CITY
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State | SD
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Zip | 57702-8114
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Country | US
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Telephone | 605-355-2260
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Fax |
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Provider Business Mailing Address
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Address Line | HC 63 BOX 253
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City | WINSLOW
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State | AZ
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Zip | 86047-9417
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D1507
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License Number State | SD
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