| Prairie Dental Center | |
|
4904 S Minnesota Ave Sioux Falls SD 57108-2864 | |
| (605) 335-8640 | |
| (605) 332-9956 |
| Full Name | Prairie Dental Center |
|---|---|
| Speciality | Dentist |
| Location | 4904 S Minnesota Ave, Sioux Falls, South Dakota |
| Authorized Official Name and Position | Justin M. Nichols (DENTIST/OWNER) |
| Authorized Official Contact | 6053358640 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prairie Dental Center 4904 S Minnesota Ave Sioux Falls SD 57108-2864 Ph: (605) 335-8640 | Prairie Dental Center 4904 S Minnesota Ave Sioux Falls SD 57108-2864 Ph: (605) 335-8640 |
| NPI Number | 1922196955 |
|---|---|
| Provider Enumeration Date | 10/11/2006 |
| Last Update Date | 09/25/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922196955 | NPI | - | NPPES |
| M631 | Other | SD | STATE LICENSE NUMBER |
| D1051 | Other | SD | STATE LICENSE NUMBER |
| D0522 | Other | SD | STATE LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | M631 (South Dakota) | Primary |
| 122300000X | Dentist | D0522 (South Dakota) | Secondary |
| 122300000X | Dentist | D1051 (South Dakota) | Secondary |
Abc Pediatric Dentistry Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 6908 S. Lyncrest Pl., Sioux Falls, SD 57108 Phone: 605-275-5771 Fax: 605-275-5772 | |
Candid South Dakota, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 519 W 22nd St Ste 100, Sioux Falls, SD 57105 Phone: 860-481-7631 | |
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