MEDICARE: DR. TARA ELIZABETH BOOMSMA DDS

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
1	122300000X	Dentist	D1242	SD

General Provider Information

NPI Number	:	1063074326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TARA ELIZABETH BOOMSMA DDS

Provider Business Mailing Address
First Line	:	108 W 4TH ST
Second Line	:
City	:	DELL RAPIDS
State	:	SD
Zip	:	57022-1508
Country	:	US
Telephone Number	:	605-428-5471
Fax Number	:

Provider Business Practice Location Address
First Line	:	2308 S WESTLAKE DR
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-8527
Country	:	US
Telephone Number	:	605-271-4422
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2019
Last Update Date	:	02/26/2024

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