MEDICARE: SIOUX FALLS DENTAL HEALTH

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	M872	SD

General Provider Information

NPI Number	:	1164729935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIOUX FALLS DENTAL HEALTH

Provider Business Mailing Address
First Line	:	3405 S CATHY AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-2702
Country	:	US
Telephone Number	:	800-516-7631
Fax Number	:	800-516-7613

Provider Business Practice Location Address
First Line	:	3405 S CATHY AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-2702
Country	:	US
Telephone Number	:	800-516-7631
Fax Number	:	800-516-7613

Authorized Official
Title or Position	:	OFFICE COORDINATOR
Name	:	HEATHER POSEY
Credential	:
Telephone Number	:	916-949-8630

Provider Enumeration Date	:	02/14/2011
Last Update Date	:	02/14/2011

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