Provider Demographics
NPI:1164538450
Name:FAMILY DENTAL CENTER P.C.
Entity Type:Organization
Organization Name:FAMILY DENTAL CENTER P.C.
Other - Org Name:JONES & COLBERT INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:SUGA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-338-9242
Mailing Address - Street 1:2001 W 45TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6265
Mailing Address - Country:US
Mailing Address - Phone:605-338-9242
Mailing Address - Fax:605-338-4867
Practice Address - Street 1:2001 W 45TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6265
Practice Address - Country:US
Practice Address - Phone:605-338-9242
Practice Address - Fax:605-338-4867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty