Provider Demographics
NPI:1962054643
Name:RAPID CITY DENTAL CLINIC
Entity type:Organization
Organization Name:RAPID CITY DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TEESLINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-342-5995
Mailing Address - Street 1:2525 W MAIN ST STE 304
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-2487
Mailing Address - Country:US
Mailing Address - Phone:605-342-1432
Mailing Address - Fax:
Practice Address - Street 1:2525 W MAIN ST STE 304
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-2487
Practice Address - Country:US
Practice Address - Phone:605-342-1432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental