MEDICARE: EMILEE GOLDY

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	124Q00000X	Dental Hygienist	DH1999	SD

General Provider Information

NPI Number	:	1093671794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILEE GOLDY

Provider Business Mailing Address
First Line	:	PO BOX 1557
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57709-1557
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1761 TABLEROCK RD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-5595
Country	:	US
Telephone Number	:	605-721-1111
Fax Number	:

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

Provider Enumeration Date	:	12/27/2025
Last Update Date	:	12/27/2025

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Directions to “ EMILEE GOLDY ” Practice Location

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