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General NPI Number Information
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NPI Number | 1396252698
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Entity Type | Organization
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Legal Business Name | DUNES PEIODONTICS AND IMPLANT DENTISTRY
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Dates
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Enumeration Date | 01/08/2018
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Last Update Date | 01/08/2018
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Provider Practice Location Address
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Address Line | 150 TOWER RD STE 110
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City | DAKOTA DUNES
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State | SD
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Zip | 57049-8000
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Country | US
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Telephone | 605-540-4477
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Fax | 605-540-0210
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Provider Business Mailing Address
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Address Line | 150 TOWER RD STE 110
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City | DAKOTA DUNES
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State | SD
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Zip | 57049-8000
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Country | US
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Telephone | 605-540-4477
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Fax | 605-540-0210
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Authorized Official
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Title or Position | OFFICE MGR
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Name | CONSTANCE DARLENE MENDOZA
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Credential |
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Telephone | 605-540-4477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | D0905
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License Number State | SD
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