Provider Demographics
NPI:1073189866
Name:NORTHERN PLAINS ENDODONTICS, PLLC
Entity Type:Organization
Organization Name:NORTHERN PLAINS ENDODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOETTSCHE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-961-9092
Mailing Address - Street 1:4824 E 57TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-8614
Mailing Address - Country:US
Mailing Address - Phone:605-961-9092
Mailing Address - Fax:605-961-9093
Practice Address - Street 1:4824 E 57TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8614
Practice Address - Country:US
Practice Address - Phone:319-610-5747
Practice Address - Fax:605-961-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-02
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA14275005056Medicaid