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General NPI Number Information
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NPI Number | 1235421702
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Entity Type | Organization
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Legal Business Name | CRIST & WENADE ORTHODONTICS PROF. LLC
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Dates
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Enumeration Date | 05/03/2011
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Last Update Date | 05/03/2011
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Provider Practice Location Address
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Address Line | 3500 S MARION RD
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City | SIOUX FALLS
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State | SD
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Zip | 57106-1370
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Country | US
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Telephone | 605-361-0016
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Fax | 605-361-0019
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Provider Business Mailing Address
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Address Line | 3500 S MARION RD
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City | SIOUX FALLS
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State | SD
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Zip | 57106-1370
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Country | US
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Telephone | 605-361-0016
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Fax | 605-361-0019
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Authorized Official
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Title or Position | CEO
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Name | DR. ROSS L CRIST
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Credential | DDS,MA,MS
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Telephone | 605-361-0016
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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 | M842
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License Number State | SD
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