MEDICARE: RAPID CITY DENTAL PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1477325736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAPID CITY DENTAL PLLC

Provider Business Mailing Address
First Line	:	2525 W MAIN ST STE 304
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-2487
Country	:	US
Telephone Number	:	605-342-1432
Fax Number	:	605-600-5649

Provider Business Practice Location Address
First Line	:	2525 W MAIN ST STE 304
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-2487
Country	:	US
Telephone Number	:	605-342-1432
Fax Number	:	605-600-5649

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	ADAM JOSIAH VAWTER
Credential	:	DDS
Telephone Number	:	509-951-8825

Provider Enumeration Date	:	10/30/2023
Last Update Date	:	10/30/2023

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Directions to “RAPID CITY DENTAL PLLC ” Practice Location

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