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705 Columbus St Rapid City SD 57701-3623 | |
| (605) 716-5622 | |
| (605) 791-2982 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 705 Columbus St, Rapid City, South Dakota |
| Authorized Official Name and Position | Justin D Moody (OWNER) |
| Authorized Official Contact | 6057165622 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
705 Columbus St Rapid City SD 57701-3623 Ph: (605) 716-5622 | 705 Columbus St Rapid City SD 57701-3623 Ph: (605) 716-5622 |
| NPI Number | 1649556978 |
|---|---|
| Provider Enumeration Date | 11/01/2011 |
| Last Update Date | 09/22/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649556978 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | M881 (South Dakota) | Primary |
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