Provider Demographics
NPI:1871207167
Name:SOUTH DAKOTA DENTAL ASSOCIATES PLLC
Entity type:Organization
Organization Name:SOUTH DAKOTA DENTAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MBA
Authorized Official - Phone:608-289-2540
Mailing Address - Street 1:3020 AURORA AVE
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-7097
Mailing Address - Country:US
Mailing Address - Phone:712-336-3037
Mailing Address - Fax:712-336-6931
Practice Address - Street 1:1110 W 5TH ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:SD
Practice Address - Zip Code:57013-1543
Practice Address - Country:US
Practice Address - Phone:605-987-2721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty