Provider Demographics
NPI:1962967455
Name:DAKOTA FAMILY DENTISTRY, PROF. LLC
Entity type:Organization
Organization Name:DAKOTA FAMILY DENTISTRY, PROF. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:FAST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-352-6999
Mailing Address - Street 1:1010 DAKOTA AVE S
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-3318
Mailing Address - Country:US
Mailing Address - Phone:605-352-6999
Mailing Address - Fax:605-352-0472
Practice Address - Street 1:1010 DAKOTA AVE S
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-3318
Practice Address - Country:US
Practice Address - Phone:605-352-6999
Practice Address - Fax:605-352-0472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental