Provider Demographics
NPI:1124363957
Name:DELTA DENTAL OF SOUTH DAKOTA FOUNDATION
Entity Type:Organization
Organization Name:DELTA DENTAL OF SOUTH DAKOTA FOUNDATION
Other - Org Name:HYGIENE PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF PUBLIC BENEFIT
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-494-2547
Mailing Address - Street 1:804 N EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-1719
Mailing Address - Country:US
Mailing Address - Phone:605-494-2547
Mailing Address - Fax:605-224-0909
Practice Address - Street 1:804 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-1719
Practice Address - Country:US
Practice Address - Phone:605-224-7345
Practice Address - Fax:605-224-0909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty