Provider Demographics
NPI:1396252698
Name:DUNES PEIODONTICS AND IMPLANT DENTISTRY
Entity type:Organization
Organization Name:DUNES PEIODONTICS AND IMPLANT DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-540-4477
Mailing Address - Street 1:150 TOWER RD STE 110
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-8000
Mailing Address - Country:US
Mailing Address - Phone:605-540-4477
Mailing Address - Fax:605-540-0210
Practice Address - Street 1:150 TOWER RD STE 110
Practice Address - Street 2:
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-8000
Practice Address - Country:US
Practice Address - Phone:605-540-4477
Practice Address - Fax:605-540-0210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD09051223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty