Provider Demographics
NPI:1235440769
Name:SHAWD NBD 26TH P.C.
Entity Type:Organization
Organization Name:SHAWD NBD 26TH P.C.
Other - Org Name:NEIGHBORHOOD DENTAL SF 26TH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:D
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-731-9599
Mailing Address - Street 1:5110 W 26TH ST
Mailing Address - Street 2:UNIT 5
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-3520
Mailing Address - Country:US
Mailing Address - Phone:605-759-5583
Mailing Address - Fax:605-339-7682
Practice Address - Street 1:5110 W 26TH ST
Practice Address - Street 2:UNIT 5
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-3520
Practice Address - Country:US
Practice Address - Phone:605-759-5583
Practice Address - Fax:605-339-7682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD09351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty