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General NPI Number Information
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NPI Number | 1699428227
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Entity Type | Organization
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Legal Business Name | BLACK HILLS IMPLANT AND FAMILY DENTAL LLC
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Dates
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Enumeration Date | 02/02/2022
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Last Update Date | 02/02/2022
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Provider Practice Location Address
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Address Line | 1300 JUNCTION AVE
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City | STURGIS
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State | SD
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Zip | 57785-1938
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Country | US
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Telephone | 605-608-0635
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Fax |
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Provider Business Mailing Address
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Address Line | 3917 MINNEKAHTA DR
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City | RAPID CITY
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State | SD
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Zip | 57702-3259
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Country | US
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Telephone | 605-608-0635
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Fax |
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Authorized Official
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Title or Position | DENIST
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Name | DR. BRIAN LEE HETTINGER
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Credential | DDS
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Telephone | 605-608-0635
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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 |
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License Number State |
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