Provider Demographics
NPI:1417070624
Name:VERMILLION DENTAL HEALTH
Entity Type:Organization
Organization Name:VERMILLION DENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-624-8695
Mailing Address - Street 1:11 COURT ST
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-3056
Mailing Address - Country:US
Mailing Address - Phone:605-624-2869
Mailing Address - Fax:
Practice Address - Street 1:11 COURT ST
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-3056
Practice Address - Country:US
Practice Address - Phone:605-624-2869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM872122300000X
SDM608122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty