Provider Demographics
NPI:1235206756
Name:SMALLCOMB, JOHN V (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:V
Last Name:SMALLCOMB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 E SLATEN PARK CIR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-4645
Mailing Address - Country:US
Mailing Address - Phone:605-371-3492
Mailing Address - Fax:
Practice Address - Street 1:5100 S CLIFF AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5475
Practice Address - Country:US
Practice Address - Phone:605-371-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM857122300000X
MND10478122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist