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General NPI Number Information
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NPI Number | 1578913232
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Entity Type | Organization
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Legal Business Name | .INDIAN HEALTH SERVICE
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Dates
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Enumeration Date | 06/14/2016
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 241 EAST MEADE ST
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City | RAPID CITY
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State | SD
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Zip | 57701
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Country | US
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Telephone | 605-341-6325
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Fax |
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Provider Business Mailing Address
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Address Line | 241 E MEADE ST
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City | RAPID CITY
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State | SD
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Zip | 57701-5657
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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 | DENTAL CHIEF
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Name | CLAUDIA VON HENDRICKS
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Credential | DDS
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Telephone | 605-355-2260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 580
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License Number State | SD
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