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NPI Code Detail

MEDICARE: NELSON & BURY DENTISTRY P.L.L.C.

MEDICARE: NELSON & BURY DENTISTRY P.L.L.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryD1111SD

General Provider Information

NPI Number : 1013422419
Entity Type Code : Organization
Provider Name (Legal Business Name) : NELSON & BURY DENTISTRY P.L.L.C.
Provider Business Mailing Address
First Line : 1611 SHERIDAN LAKE RD
Second Line :
City : RAPID CITY
State : SD
Zip : 57702-3423
Country : US
Telephone Number : 605-341-3670
Fax Number :
Provider Business Practice Location Address
First Line : 1611 SHERIDAN LAKE RD
Second Line :
City : RAPID CITY
State : SD
Zip : 57702-3423
Country : US
Telephone Number : 605-341-3670
Fax Number :
Authorized Official
Title or Position : PRESIDENT/ DENTIST
Name : DR. MATTHEW D BURY
Credential : DDS
Telephone Number : 605-393-7364
Provider Enumeration Date : 12/06/2017
Last Update Date : 12/06/2017

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Directions to “NELSON & BURY DENTISTRY P.L.L.C. ” Practice Location

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