Provider Demographics
NPI:1215153218
Name:SCHUURMANS, BERNARD VIRGIL (DDS)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:VIRGIL
Last Name:SCHUURMANS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 NE 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:SD
Mailing Address - Zip Code:57042-2348
Mailing Address - Country:US
Mailing Address - Phone:605-256-2670
Mailing Address - Fax:605-256-3172
Practice Address - Street 1:502 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:SD
Practice Address - Zip Code:57042-2348
Practice Address - Country:US
Practice Address - Phone:605-256-2670
Practice Address - Fax:605-256-3172
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM-4651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7800860Medicaid