Provider Demographics
NPI:1285073742
Name:ST.FRANCIS MISSION DENTAL CLINIC
Entity type:Organization
Organization Name:ST.FRANCIS MISSION DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAROUF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-747-2142
Mailing Address - Street 1:350 OAK ST.
Mailing Address - Street 2:
Mailing Address - City:ST.FRANCIS
Mailing Address - State:SD
Mailing Address - Zip Code:57572
Mailing Address - Country:US
Mailing Address - Phone:605-747-2142
Mailing Address - Fax:
Practice Address - Street 1:350 OAK ST.
Practice Address - Street 2:
Practice Address - City:ST.FRANCIS
Practice Address - State:SD
Practice Address - Zip Code:57572
Practice Address - Country:US
Practice Address - Phone:605-747-2142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST.FRANICS MISSION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM839261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental