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General NPI Number Information
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NPI Number | 1750633004
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Entity Type | Organization
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Legal Business Name | DAKOTA ENT AND SINUS CLINIC, P.C.
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Dates
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Enumeration Date | 10/11/2012
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Last Update Date | 12/10/2012
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Provider Practice Location Address
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Address Line | 6709 S MINNESOTA AVE SUITE 206
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City | SIOUX FALLS
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State | SD
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Zip | 57108-2592
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Country | US
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Telephone | 605-575-1000
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Fax | 605-575-1004
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Provider Business Mailing Address
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Address Line | 6709 S MINNESOTA AVE SUITE 206
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City | SIOUX FALLS
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State | SD
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Zip | 57108-2592
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Country | US
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Telephone | 605-575-1000
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Fax | 605-575-1004
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK GREGORY DESAUTEL
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Credential | MD
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Telephone | 605-575-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207YX0602X
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Taxonomy Name | Otolaryngic Allergy Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207YX0901X
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Taxonomy Name | Otology & Neurotology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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