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General NPI Number Information
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NPI Number | 1225731821
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Entity Type | Organization
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Legal Business Name | DELTA DENTAL OF SOUTH DAKOTA FOUNDATION
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Dates
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Enumeration Date | 03/23/2023
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Last Update Date | 03/23/2023
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Provider Practice Location Address
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Address Line | 804 N EUCLID AVE STE 1
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City | PIERRE
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State | SD
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Zip | 57501-1738
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Country | US
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Telephone | 605-224-2547
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Fax | 605-224-2578
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Provider Business Mailing Address
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Address Line | 804 N EUCLID AVE STE 1
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City | PIERRE
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State | SD
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Zip | 57501-1738
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Country | US
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Telephone | 605-224-2547
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Fax | 605-224-2578
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Authorized Official
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Title or Position | VP OF PUBLIC BENEFIT
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Name | CONNIE HALVERSON
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Credential |
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Telephone | 605-494-2547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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