Organization Name: | CHAMBERLAIN FAMILY DENTISTRY |
NPI Number: | 1962884155 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ZACHARY R MCCREADY (PRESIDENT) |
Mailing Address: | 110 W Mott Ave Chamberlain |
State: | SD US |
Postal Code: | 573251244 |
Phone Number: | 6057346028 |
Fax Number: | 6057346029 |
NPI Enumeration Date: | 06/24/2015 |
NPI Last Update Date: | 06/24/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | D1085 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SD |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |