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General NPI Number Information
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NPI Number | 1649629957
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Entity Type | Organization
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Legal Business Name | EAR NOSE AND THROAT CONSULTANTS
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Dates
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Enumeration Date | 06/07/2016
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Last Update Date | 06/29/2016
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Provider Practice Location Address
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Address Line | 101 TOWER ROAD SUITE 110
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City | DAKOTA DUNES
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State | SD
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Zip | 57049
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Country | US
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Telephone | 605-217-4320
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Fax | 605-217-2948
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Provider Business Mailing Address
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Address Line | 101 TOWER ROAD SUITE 120
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City | DAKOTA DUNES
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State | SD
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Zip | 57049
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Country | US
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Telephone | 605-217-4320
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Fax | 605-217-2948
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | KELLY A JERDEE
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Credential |
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Telephone | 605-217-4320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1919
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License Number State | SD
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