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NPI Code Detail

MEDICARE: SHAWD NEIGHBORHOOD DENTAL CLINIC P.C.

MEDICARE: SHAWD NEIGHBORHOOD DENTAL CLINIC P.C.
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 DentistryM993SD

General Provider Information

NPI Number : 1528226958
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHAWD NEIGHBORHOOD DENTAL CLINIC P.C.
Provider Business Mailing Address
First Line : 229 W 39TH ST
Second Line : STE. 100
City : SIOUX FALLS
State : SD
Zip : 57105-5700
Country : US
Telephone Number : 605-338-2251
Fax Number : 605-338-2788
Provider Business Practice Location Address
First Line : 229 W 39TH ST
Second Line : STE. 100
City : SIOUX FALLS
State : SD
Zip : 57105-5700
Country : US
Telephone Number : 605-338-2251
Fax Number : 605-338-2788
Authorized Official
Title or Position : OWNER
Name : DR. NICHOLAS JON SHAWD
Credential : D.D.S.
Telephone Number : 605-338-2251
Provider Enumeration Date : 06/02/2008
Last Update Date : 06/02/2008

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Directions to “SHAWD NEIGHBORHOOD DENTAL CLINIC P.C. ” Practice Location

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