Provider Demographics
NPI:1093840969
Name:MAHER DENTAL CLINIC, PROF. LLC
Entity Type:Organization
Organization Name:MAHER DENTAL CLINIC, PROF. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MAHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-224-8858
Mailing Address - Street 1:401 E SIOUX AVE
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-3162
Mailing Address - Country:US
Mailing Address - Phone:605-224-8858
Mailing Address - Fax:605-224-8859
Practice Address - Street 1:401 E SIOUX AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-3162
Practice Address - Country:US
Practice Address - Phone:605-224-8858
Practice Address - Fax:605-224-8859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM994122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7809990Medicaid