Provider Demographics
NPI:1063265171
Name:SMILE DOCTORS OF SOUTH DAKOTA, PLLC
Entity type:Organization
Organization Name:SMILE DOCTORS OF SOUTH DAKOTA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER & SOLE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WERMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:817-988-3476
Mailing Address - Street 1:5400 LBJ FWY STE 800
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-1058
Mailing Address - Country:US
Mailing Address - Phone:817-988-3476
Mailing Address - Fax:
Practice Address - Street 1:6801 S MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2568
Practice Address - Country:US
Practice Address - Phone:605-274-0555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty