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NPI Code Detail

MEDICARE: DR. DEAN R MARIETTA M.D.

MEDICARE: DR. DEAN R MARIETTA M.D.
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
1207L00000XAnesthesiology Physician4946SD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2WELLMARKOTHERSD0008114

General Provider Information

NPI Number : 1538148119
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DEAN R MARIETTA M.D.
Provider Business Mailing Address
First Line : PO BOX 2760
Second Line :
City : RAPID CITY
State : SD
Zip : 57709-2760
Country : US
Telephone Number : 605-343-1333
Fax Number : 605-343-6017
Provider Business Practice Location Address
First Line : 353 FAIRMONT BLVD
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-7375
Country : US
Telephone Number : 605-343-1333
Fax Number : 605-343-6017
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2006
Last Update Date : 10/18/2007

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Directions to “ DR. DEAN R MARIETTA M.D.” Practice Location

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