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General NPI Number Information
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NPI Number | 1164729935
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Entity Type | Organization
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Legal Business Name | SIOUX FALLS DENTAL HEALTH
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Dates
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Enumeration Date | 02/14/2011
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Last Update Date | 02/14/2011
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Provider Practice Location Address
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Address Line | 3405 S CATHY AVE
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City | SIOUX FALLS
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State | SD
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Zip | 57106-2702
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Country | US
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Telephone | 800-516-7631
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Fax | 800-516-7613
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Provider Business Mailing Address
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Address Line | 3405 S CATHY AVE
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City | SIOUX FALLS
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State | SD
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Zip | 57106-2702
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Country | US
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Telephone | 800-516-7631
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Fax | 800-516-7613
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Authorized Official
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Title or Position | OFFICE COORDINATOR
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Name | HEATHER POSEY
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Credential |
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Telephone | 916-949-8630
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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 | M872
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License Number State | SD
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