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NPI Code Detail

MEDICARE: DR. GLEN RANDAL SACHAU DDS

MEDICARE:  DR. GLEN RANDAL SACHAU  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
11223G0001XGeneral Practice DentistryM-512SD

General Provider Information

NPI Number : 1518912914
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GLEN RANDAL SACHAU DDS
Provider Business Mailing Address
First Line : 1440 N 10TH ST
Second Line :
City : SPEARFISH
State : SD
Zip : 57783-1532
Country : US
Telephone Number : 605-642-5767
Fax Number : 605-642-5769
Provider Business Practice Location Address
First Line : 1440 N 10TH ST
Second Line :
City : SPEARFISH
State : SD
Zip : 57783-1532
Country : US
Telephone Number : 605-642-5767
Fax Number : 605-642-5769
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2006
Last Update Date : 04/11/2018

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Directions to “ DR. GLEN RANDAL SACHAU DDS” Practice Location

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