Provider Demographics
NPI:1407074586
Name:ORTHODONTIC,LTD
Entity Type:Organization
Organization Name:ORTHODONTIC,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDSMSD
Authorized Official - Phone:605-335-6665
Mailing Address - Street 1:600 W 37TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-5601
Mailing Address - Country:US
Mailing Address - Phone:605-335-6665
Mailing Address - Fax:605-332-5510
Practice Address - Street 1:600 W 37TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-5601
Practice Address - Country:US
Practice Address - Phone:605-335-6665
Practice Address - Fax:605-332-5510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM4061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty