Provider Demographics
NPI:1962615344
Name:MCCOOK COUNTY DENTALCENTER,PC
Entity type:Organization
Organization Name:MCCOOK COUNTY DENTALCENTER,PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-425-2725
Mailing Address - Street 1:440 EAST RUTAN AVENUE
Mailing Address - Street 2:PO BOX 549
Mailing Address - City:SALEM
Mailing Address - State:SD
Mailing Address - Zip Code:57058-0549
Mailing Address - Country:US
Mailing Address - Phone:605-425-2725
Mailing Address - Fax:605-425-9724
Practice Address - Street 1:440 EAST RUTAN AVENUE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:SD
Practice Address - Zip Code:57058-0549
Practice Address - Country:US
Practice Address - Phone:605-425-2725
Practice Address - Fax:605-425-9724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM6751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty